Provider Demographics
NPI:1003090671
Name:ST GEORGE, CHARLES EDWARD III (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:ST GEORGE
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:4141 WESTERN DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326
Mailing Address - Country:US
Mailing Address - Phone:928-646-9220
Mailing Address - Fax:928-646-7266
Practice Address - Street 1:4141 WESTERN DR
Practice Address - Street 2:SUITE D
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326
Practice Address - Country:US
Practice Address - Phone:928-646-9220
Practice Address - Fax:928-646-7266
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2012-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor