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General NPI Number Information
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NPI Number | 1043605504
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Entity Type | Organization
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Legal Business Name | GLASS VELICHKO CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 435 8TH ST SUITE 203
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City | OAKLAND
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State | CA
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Zip | 94607-3963
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Country | US
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Telephone | 510-858-5370
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Fax |
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Provider Business Mailing Address
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Address Line | 435 8TH ST SUITE 203
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City | OAKLAND
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State | CA
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Zip | 94607-3963
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Country | US
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Telephone | 510-858-5370
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/VICE PRESIDENT/CO-OWNE
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Name | IRINA VELICHKO
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Credential | D.C.
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Telephone | 510-858-5370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 33186
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 32669
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License Number State | CA
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