Provider Demographics
NPI:1689673170
Name:JUNKIN, GEORGE GLENN (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GLENN
Last Name:JUNKIN
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 1:11500 NORTHWEST FWY STE 201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-6524
Mailing Address - Country:US
Mailing Address - Phone:713-686-0828
Mailing Address - Fax:713-686-4151
Practice Address - Street 1:11500 NORTHWEST FWY STE 201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6524
Practice Address - Country:US
Practice Address - Phone:713-686-0828
Practice Address - Fax:713-686-4151
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2593111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600902Medicare ID - Type UnspecifiedMEDICARE
TXT14109Medicare UPIN