Provider Demographics
NPI:1710176011
Name:PACK, DONALD GEORGE (DC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:GEORGE
Last Name:PACK
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 1:5814 VAN ALLEN WAY
Mailing Address - Street 2:SUITE 175
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7358
Mailing Address - Country:US
Mailing Address - Phone:760-602-0262
Mailing Address - Fax:760-602-0171
Practice Address - Street 1:5814 VAN ALLEN WAY
Practice Address - Street 2:SUITE 175
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7360
Practice Address - Country:US
Practice Address - Phone:760-602-0262
Practice Address - Fax:760-602-0171
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor