Provider Demographics
NPI:1790756120
Name:BREWSTER, GEORGE EVERETT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EVERETT
Last Name:BREWSTER
Suffix:JR
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 1:235 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-1924
Mailing Address - Country:US
Mailing Address - Phone:973-492-1568
Mailing Address - Fax:973-492-0279
Practice Address - Street 1:235 UNION AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07403-1924
Practice Address - Country:US
Practice Address - Phone:973-492-1568
Practice Address - Fax:973-492-0279
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00203800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
099604Medicare PIN