Healthcare Provider Details

I. General information

NPI: 1326030461
Provider Name (Legal Business Name): LATOYA NASHAGE GLASS-SHERMAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 183RD ST
COUNTRY CLUB HILLS IL
60478-5306
US

IV. Provider business mailing address

4023 183RD ST
COUNTRY CLUB HILLS IL
60478-5306
US

V. Phone/Fax

Practice location:
  • Phone: 708-799-7855
  • Fax: 708-799-7866
Mailing address:
  • Phone: 708-799-7855
  • Fax: 708-799-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-010238
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: