Provider Demographics
NPI:1508868225
Name:BAKALIS, GEORGE N (DC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:N
Last Name:BAKALIS
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 1:2026B OPITZ BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3306
Mailing Address - Country:US
Mailing Address - Phone:703-491-8888
Mailing Address - Fax:703-491-2244
Practice Address - Street 1:2026B OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3306
Practice Address - Country:US
Practice Address - Phone:703-491-8888
Practice Address - Fax:703-491-2244
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor