Provider Demographics
NPI:1285938753
Name:GLIMPSE, DANIEL ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ERIC
Last Name:GLIMPSE
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 1:1141 PACIFIC ST STE E
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3379
Mailing Address - Country:US
Mailing Address - Phone:408-644-0192
Mailing Address - Fax:
Practice Address - Street 1:1141 PACIFIC ST STE E
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3379
Practice Address - Country:US
Practice Address - Phone:408-644-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor