Provider Demographics
NPI:1437680436
Name:GEORGE, TODD (LAC, MSOM, DIPL OM)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:LAC, MSOM, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S MCDOWELL ST
Mailing Address - Street 2:SUITE 907
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2623
Mailing Address - Country:US
Mailing Address - Phone:704-333-8899
Mailing Address - Fax:704-333-8090
Practice Address - Street 1:301 S MCDOWELL ST
Practice Address - Street 2:SUITE 907
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2623
Practice Address - Country:US
Practice Address - Phone:704-333-8899
Practice Address - Fax:704-333-8090
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC371171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty