Provider Demographics
NPI:1619042116
Name:HARRAKA, GEORGE JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JAMES
Last Name:HARRAKA
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 1:8632 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4013
Mailing Address - Country:US
Mailing Address - Phone:310-348-8298
Mailing Address - Fax:310-348-8299
Practice Address - Street 1:8632 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTCHESTER
Practice Address - State:CA
Practice Address - Zip Code:90045-4013
Practice Address - Country:US
Practice Address - Phone:310-348-8298
Practice Address - Fax:310-348-8299
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ223474076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223474076OtherTIN
NJ223474076OtherTIN