Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 5567 | AZ |
NPI | 1023133139 |
---|---|
Provider Name | Dr. Glenn Micheels |
First Address | Peoria, AZ 85383-1938 |
Second Address | Glendale, AZ 85308-4025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |