Provider Demographics
NPI:1467553412
Name:DR. CALVIN R GEORGE PC
Entity Type:Organization
Organization Name:DR. CALVIN R GEORGE PC
Other - Org Name:GEORGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-599-0950
Mailing Address - Street 1:190 N SWIFT RD
Mailing Address - Street 2:SUITE S
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1476
Mailing Address - Country:US
Mailing Address - Phone:630-599-0950
Mailing Address - Fax:630-599-0952
Practice Address - Street 1:190 N SWIFT RD
Practice Address - Street 2:SUITE S
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1476
Practice Address - Country:US
Practice Address - Phone:630-599-0950
Practice Address - Fax:630-599-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL002282063OtherBCBS PROVIDER #
IL211357Medicare ID - Type UnspecifiedPROVIDER NUMBER
ILT37569Medicare UPIN