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General NPI Number Information
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NPI Number | 1184160897
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Entity Type | Organization
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Legal Business Name | HERMAN J GLASS II
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 17301 W 8 MILE RD
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City | DETROIT
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State | MI
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Zip | 48235-2141
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Country | US
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Telephone | 313-533-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 17301 W 8 MILE RD
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City | DETROIT
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State | MI
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Zip | 48235-2141
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HERMAN GLASS
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Credential | DC
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Telephone | 313-533-2225
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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 | 2301004962
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License Number State | MI
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