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General NPI Number Information
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NPI Number | 1952460065
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Entity Type | Organization
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Legal Business Name | PODELL CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 840 N NORMA ST STE B
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City | RIDGECREST
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State | CA
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Zip | 93555-3570
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Country | US
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Telephone | 760-371-1300
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Fax | 760-384-2100
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Provider Business Mailing Address
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Address Line | 840 N NORMA ST STE B
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City | RIDGECREST
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State | CA
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Zip | 93555-3570
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Country | US
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Telephone | 760-371-1300
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Fax | 760-384-2100
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Authorized Official
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Title or Position | OWNER
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Name | DR. GLENN CARTER PODELL
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Credential | D.C.
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Telephone | 760-371-1300
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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 | 12017
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License Number State | CA
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