Healthcare Provider Details

I. General information

NPI: 1033242102
Provider Name (Legal Business Name): MAURICIO GLASER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3571 CHAMBLEE TUCKER RD
ATLANTA GA
30341-4409
US

IV. Provider business mailing address

PO BOX 941188
ATLANTA GA
31141-0188
US

V. Phone/Fax

Practice location:
  • Phone: 678-701-2225
  • Fax: 678-701-2226
Mailing address:
  • Phone: 678-701-2225
  • Fax: 678-701-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8643
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHRI007588
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: