Provider Demographics
NPI:1821174111
Name:CHEN, GEORGE G (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:G
Last Name:CHEN
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 1:3695 WAYNESVILL ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-4111
Mailing Address - Country:US
Mailing Address - Phone:914-715-3475
Mailing Address - Fax:
Practice Address - Street 1:3695 WAYNESVILL ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-4111
Practice Address - Country:US
Practice Address - Phone:914-715-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU72889Medicare UPIN
NYX7B081Medicare ID - Type Unspecified