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General NPI Number Information
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NPI Number | 1740338128
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Entity Type | Organization
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Legal Business Name | GLENN S CLOUD, DC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 417 W LA HABRA BLVD
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City | LA HABRA
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State | CA
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Zip | 90631
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Country | US
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Telephone | 562-691-2225
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Fax | 562-691-9725
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Provider Business Mailing Address
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Address Line | 417 W LA HABRA BLVD
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City | LA HABRA
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State | CA
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Zip | 90631
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Country | US
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Telephone | 562-691-2225
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Fax | 562-691-9725
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Authorized Official
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Title or Position | OWNER CHIROPRACTOR
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Name | MR. GLENN STANLEY CLOUD
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Credential | DC CHIROPRACTOR
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Telephone | 562-691-2225
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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 | 14340
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License Number State | CA
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