Provider Demographics
NPI:1689752859
Name:GEORGE, ROBERT E (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
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 1:503 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2237
Mailing Address - Country:US
Mailing Address - Phone:814-333-9633
Mailing Address - Fax:
Practice Address - Street 1:503 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2237
Practice Address - Country:US
Practice Address - Phone:814-333-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012621250003Medicaid
PA205202OtherUPMC
PA205202OtherUPMC
PA519053Medicare ID - Type Unspecified