Provider Demographics
NPI:1558444315
Name:PAPADOPOULOS, GEORGE PETER (DC, ATC/L, RKT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PETER
Last Name:PAPADOPOULOS
Suffix:
Gender:M
Credentials:DC, ATC/L, RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 W BOUGHTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1378
Mailing Address - Country:US
Mailing Address - Phone:630-226-5754
Mailing Address - Fax:630-226-9908
Practice Address - Street 1:454 W BOUGHTON RD STE B
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1378
Practice Address - Country:US
Practice Address - Phone:630-226-5754
Practice Address - Fax:630-226-9908
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932151OtherBCBS
ILU91728Medicare ID - Type UnspecifiedMEDICARE
IL09932151OtherBCBS