Individual
GLEN PATRICK ALIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
30320 RANCHO VIEJO RD STE 103, SAN JUAN CAPISTRANO, CA 92675-1582
(949) 218-4520
(949) 218-4172
Mailing address
30320 RANCHO VIEJO RD STE 103, SAN JUAN CAPISTRANO, CA 92675-1582
(949) 218-4520
(949) 218-4172
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
DC26006
CA
Other
Enumeration date
02/14/2007
Last updated
07/08/2007
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