Provider Demographics
NPI:1023186780
Name:DAVIS, GLENDA SENCERE
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:SENCERE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32605 STATE HWY 79 SOUTH
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-693-5145
Mailing Address - Fax:951-693-4423
Practice Address - Street 1:32605 STATE HWY 79 SOUTH
Practice Address - Street 2:SUITE 210
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-693-5145
Practice Address - Fax:951-693-4423
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor