Healthcare Provider Details

I. General information

NPI: 1881660629
Provider Name (Legal Business Name): DANIEL GLASSMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8617 W UNION HILLS DR SUITE 100
PEORIA AZ
85382-7001
US

IV. Provider business mailing address

8617 W UNION HILLS DR SUITE 100
PEORIA AZ
85382-7001
US

V. Phone/Fax

Practice location:
  • Phone: 623-979-2263
  • Fax: 623-334-5095
Mailing address:
  • Phone: 623-979-2263
  • Fax: 623-334-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number986
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: