Healthcare Provider Details

I. General information

NPI: 1093887614
Provider Name (Legal Business Name): GLEN ROBERT CAUBLE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8586 WARNER AVE
FOUNTAIN VALLEY CA
92708-3131
US

IV. Provider business mailing address

8586 WARNER AVE
FOUNTAIN VALLEY CA
92708-3131
US

V. Phone/Fax

Practice location:
  • Phone: 714-841-4300
  • Fax: 714-848-1226
Mailing address:
  • Phone: 714-841-4300
  • Fax: 714-848-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC23762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: