Provider Demographics
NPI:1699859116
Name:BALCARCEL, GEORGE LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LOUIS
Last Name:BALCARCEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JORGE
Other - Middle Name:LUIS
Other - Last Name:BALCARCEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:14855 MONO WAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9252
Mailing Address - Country:US
Mailing Address - Phone:209-536-0733
Mailing Address - Fax:209-536-0741
Practice Address - Street 1:14855 MONO WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9252
Practice Address - Country:US
Practice Address - Phone:209-536-0733
Practice Address - Fax:209-536-0741
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0284540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8703436Medicaid
CA8703436Medicaid
CAU95944Medicare UPIN