Individual
AL GLAZA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
146 HIGHWAY 274, LAKE WYLIE, SC 29710-6045
(803) 831-2345
(803) 831-2007
Mailing address
110 GREEN MEADOW CT, GASTONIA, NC 28056-7112
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1193
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GCH293
—
SC
Enumeration date
03/22/2006
Last updated
07/08/2007
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