Provider Demographics
NPI:1093994709
Name:KARL G GEORGE DC PC
Entity Type:Organization
Organization Name:KARL G GEORGE DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC LAC
Authorized Official - Phone:631-751-0900
Mailing Address - Street 1:375 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3832
Mailing Address - Country:US
Mailing Address - Phone:631-751-0900
Mailing Address - Fax:631-751-0901
Practice Address - Street 1:375 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3832
Practice Address - Country:US
Practice Address - Phone:631-751-0900
Practice Address - Fax:631-751-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX13702Medicare PIN