Provider Demographics
NPI:1083313548
Name:CG CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CG CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-488-2573
Mailing Address - Street 1:525 N PARK AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3227
Mailing Address - Country:US
Mailing Address - Phone:714-488-2573
Mailing Address - Fax:346-755-0039
Practice Address - Street 1:525 N PARK AVE STE 120
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3227
Practice Address - Country:US
Practice Address - Phone:714-488-2573
Practice Address - Fax:346-755-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1861041964OtherCHRISTINE GEORGE