Provider Demographics
NPI:1407878580
Name:CASE, GEORGE D (DC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:D
Last Name:CASE
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 1:240 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529
Mailing Address - Country:US
Mailing Address - Phone:919-772-1113
Mailing Address - Fax:919-772-2724
Practice Address - Street 1:240 NEW FIDELITY CT
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529
Practice Address - Country:US
Practice Address - Phone:919-772-1113
Practice Address - Fax:919-772-2724
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908300Medicaid
NC08300OtherBLUE CROSS & BLUE SHIELD
NCP00002594OtherRAILROAD MEDICARE
NCT64383Medicare UPIN
NC7908300Medicaid