Provider Demographics
NPI:1912184441
Name:ORNDORFF, GEORGE ROBERT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ROBERT
Last Name:ORNDORFF
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 1:606 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-3468
Mailing Address - Country:US
Mailing Address - Phone:662-473-5280
Mailing Address - Fax:662-473-5281
Practice Address - Street 1:606 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-3468
Practice Address - Country:US
Practice Address - Phone:662-473-5280
Practice Address - Fax:662-473-5281
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512I350020OtherMEDICARE PTAN
MS07670510Medicaid