Provider Demographics
NPI:1619376167
Name:GEORGE, ALYSSA ELLA (DC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ELLA
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3823
Mailing Address - Country:US
Mailing Address - Phone:973-957-0200
Mailing Address - Fax:
Practice Address - Street 1:295 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3823
Practice Address - Country:US
Practice Address - Phone:973-957-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00722400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor