Provider Demographics
NPI:1457495178
Name:BLUNT, GEORGE BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BRIAN
Last Name:BLUNT
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 1:1524 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2933
Mailing Address - Country:US
Mailing Address - Phone:989-773-9355
Mailing Address - Fax:989-773-5594
Practice Address - Street 1:1524 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2933
Practice Address - Country:US
Practice Address - Phone:989-773-9355
Practice Address - Fax:989-773-5594
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI004182OtherLICENSE
MI950C75007OtherBCBS
MIT32922Medicare UPIN
MI004182OtherLICENSE