Healthcare Provider Details

I. General information

NPI: 1538452826
Provider Name (Legal Business Name): GLASGOW CHIROPRACTIC AND REHABILITATION P.L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 N UNIVERSITY PKWY #6B
PROVO UT
84604-1509
US

IV. Provider business mailing address

2230 N UNIVERSITY PKWY #6B
PROVO UT
84604-1509
US

V. Phone/Fax

Practice location:
  • Phone: 801-235-9944
  • Fax: 801-235-9955
Mailing address:
  • Phone: 801-235-9944
  • Fax: 801-235-9955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number74641861202
License Number StateUT

VIII. Authorized Official

Name: DR. KIMBERLY K GLASGOW
Title or Position: OWNER
Credential: D.C, M.S.
Phone: 801-235-9944