Provider Demographics
NPI:1326746777
Name:DIMOV, GEORGI STAMATOV (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGI
Middle Name:STAMATOV
Last Name:DIMOV
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 1:5400 S WILLIAMSON BLVD APT 1-214
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6502
Mailing Address - Country:US
Mailing Address - Phone:571-426-6061
Mailing Address - Fax:
Practice Address - Street 1:5400 S WILLIAMSON BLVD APT 2-201
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6531
Practice Address - Country:US
Practice Address - Phone:571-426-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA93347225700000X
FLCH14415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist