Healthcare Provider Details

I. General information

NPI: 1942528385
Provider Name (Legal Business Name): GLENDALE CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9971 W CAMELBACK RD SUITE 105
PHOENIX AZ
85037-5011
US

IV. Provider business mailing address

4432 N MILLER RD SUITE 102
SCOTTSDALE AZ
85251-3697
US

V. Phone/Fax

Practice location:
  • Phone: 623-872-0002
  • Fax: 623-872-1112
Mailing address:
  • Phone: 480-945-0008
  • Fax: 480-945-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. MICHAEL CORMIER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 480-945-0008