Provider Demographics
NPI:1902500408
Name:STEPHANIE GLOVER CHIROPRACTIC INC
Entity Type:Organization
Organization Name:STEPHANIE GLOVER CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:CHEN
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-271-5240
Mailing Address - Street 1:31042 PASEO VALENCIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2949
Mailing Address - Country:US
Mailing Address - Phone:714-271-5240
Mailing Address - Fax:
Practice Address - Street 1:1502 N EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-5906
Practice Address - Country:US
Practice Address - Phone:949-498-6440
Practice Address - Fax:949-498-6441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty