Provider Demographics
NPI:1861639163
Name:GEORGE, DALLAS S (DC)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:S
Last Name:GEORGE
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 1:296 W 2350 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7630
Mailing Address - Country:US
Mailing Address - Phone:801-635-8029
Mailing Address - Fax:801-860-6664
Practice Address - Street 1:395 N 200 W
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7045
Practice Address - Country:US
Practice Address - Phone:801-295-6667
Practice Address - Fax:801-295-6664
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT72128261202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor