Provider Demographics
NPI:1942285499
Name:MISKOVIC, GEORGE DURO (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DURO
Last Name:MISKOVIC
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 1:23100 PACIFIC HWY S STE 201
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-7281
Mailing Address - Country:US
Mailing Address - Phone:206-824-9500
Mailing Address - Fax:206-824-9654
Practice Address - Street 1:23100 PACIFIC HWY S STE 201
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-7281
Practice Address - Country:US
Practice Address - Phone:206-824-9500
Practice Address - Fax:206-824-9654
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1036111N00000X
WACH00034290111N00000X
IL038-010377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010150924OtherREGENCE BLUESHIELD
IDC3753OtherBLUE CROSS
ID806845400Medicaid
ID000010150923OtherREGENCE BLUESHIELD
IDC3753OtherBLUE CROSS
ID1675364Medicare ID - Type Unspecified