Provider Demographics
NPI:1891724423
Name:GEORGIA, JAMES (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GEORGIA
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 1:2315 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8659
Mailing Address - Country:US
Mailing Address - Phone:636-978-6995
Mailing Address - Fax:
Practice Address - Street 1:2315 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8659
Practice Address - Country:US
Practice Address - Phone:636-978-6995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU66621Medicare UPIN
MO000031850Medicare PIN