Provider Demographics
NPI:1861552929
Name:GLASKIN-CLAY, MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GLASKIN-CLAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 MCHENRY RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1385
Mailing Address - Country:US
Mailing Address - Phone:847-276-2868
Mailing Address - Fax:847-276-2783
Practice Address - Street 1:1411 MCHENRY RD
Practice Address - Street 2:SUITE 225
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1385
Practice Address - Country:US
Practice Address - Phone:847-276-2868
Practice Address - Fax:847-276-2783
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38008989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL13894889OtherBCBS OF ILLINOIS
ILU88475Medicare UPIN
IL200636Medicare ID - Type UnspecifiedPROVIDER NUMBER