Provider Demographics
NPI:1437105343
Name:WETHERINGTON, GEORGE EDWARD (DC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EDWARD
Last Name:WETHERINGTON
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 1:102 SOUTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457
Mailing Address - Country:US
Mailing Address - Phone:318-357-0270
Mailing Address - Fax:318-357-0270
Practice Address - Street 1:102 SOUTH DRIVE
Practice Address - Street 2:NATCHITOCHES CHIROPRACTIC OFFICE
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457
Practice Address - Country:US
Practice Address - Phone:318-357-0270
Practice Address - Fax:318-357-0270
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
7212006380003OtherSIGNA
440148OtherUNITED HEALTH CARE
7212006380003OtherSIGNA
T20036Medicare UPIN