Provider Demographics
NPI:1568947760
Name:GEORGE, LEO (DC)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:GEORGE
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 1:7039 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1705
Mailing Address - Country:US
Mailing Address - Phone:484-462-0969
Mailing Address - Fax:484-466-3248
Practice Address - Street 1:7039 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1705
Practice Address - Country:US
Practice Address - Phone:484-462-0969
Practice Address - Fax:484-466-3248
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000979111N00000X
PADC011409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor