Healthcare Provider Details

I. General information

NPI: 1912267857
Provider Name (Legal Business Name): CENTRAL PHOENIX CHIROPRACTIC CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
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:
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: DR. DANIEL GLASSMAN
Title or Position: OWNER/DIRECTOR
Credential: D.C.
Phone: 623-979-2263