Healthcare Provider Details

I. General information

NPI: 1407484405
Provider Name (Legal Business Name): CHRISTINA GLUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LIBERTY LN
WEST CARROLLTON OH
45449-2135
US

IV. Provider business mailing address

700 LIBERTY LN
WEST CARROLLTON OH
45449-2135
US

V. Phone/Fax

Practice location:
  • Phone: 937-247-2400
  • Fax:
Mailing address:
  • Phone: 937-247-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: