Provider Demographics
NPI:1790300127
Name:DR. GEORGE BLACKWELL INC.
Entity Type:Organization
Organization Name:DR. GEORGE BLACKWELL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:386-451-6561
Mailing Address - Street 1:1967 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5536
Mailing Address - Country:US
Mailing Address - Phone:772-335-3110
Mailing Address - Fax:772-398-0704
Practice Address - Street 1:1967 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5536
Practice Address - Country:US
Practice Address - Phone:772-335-3110
Practice Address - Fax:772-398-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty