Provider Demographics
NPI:1588626329
Name:HIBNER, GEORGE EDWARD (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:HIBNER
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W NORTH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2485
Mailing Address - Country:US
Mailing Address - Phone:623-334-5010
Mailing Address - Fax:
Practice Address - Street 1:15182 N 75TH AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4722
Practice Address - Country:US
Practice Address - Phone:623-334-5010
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41723Medicare UPIN