Provider Demographics
NPI:1073547576
Name:GEORGEKOPOULOS, GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:GEORGEKOPOULOS
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 1:204 WAKEFIELD RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9222
Mailing Address - Country:US
Mailing Address - Phone:330-705-0860
Mailing Address - Fax:
Practice Address - Street 1:204 WAKEFIELD RUN BLVD
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:OH
Practice Address - Zip Code:44233-9222
Practice Address - Country:US
Practice Address - Phone:330-705-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2184612Medicaid
OH7286054OtherAETNA
OH000000248786OtherANTHEM BC/BS
OH7286054OtherAETNA
OHU76174Medicare UPIN