Provider Demographics
NPI:1700840246
Name:BATENCHUK, GEORGE BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BRIAN
Last Name:BATENCHUK
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 1:6940 FREDERICKSBURG DR S
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3229
Mailing Address - Country:US
Mailing Address - Phone:419-824-0763
Mailing Address - Fax:419-824-0763
Practice Address - Street 1:5967 TELEGRAPH RD
Practice Address - Street 2:STE A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-4548
Practice Address - Country:US
Practice Address - Phone:800-442-1202
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4573111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU16382Medicare UPIN
TX605188Medicare ID - Type UnspecifiedCHIROPRACTIC