Provider Demographics
NPI:1750322681
Name:HATZAKOS, GEORGE (DC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:HATZAKOS
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 1:1306 KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-8323
Mailing Address - Country:US
Mailing Address - Phone:610-253-2225
Mailing Address - Fax:610-253-6687
Practice Address - Street 1:1306 KNOX AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8323
Practice Address - Country:US
Practice Address - Phone:610-253-2225
Practice Address - Fax:610-253-6687
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006504-L111N00000X
NJ38MC00636900111N00000X
NYX008083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHA836430Medicare ID - Type Unspecified
PAU60019Medicare UPIN