Provider Demographics
NPI:1952324717
Name:GEORGE, CINDY ANNE (DC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:ANNE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2547
Mailing Address - Country:US
Mailing Address - Phone:707-762-1111
Mailing Address - Fax:707-763-9040
Practice Address - Street 1:801 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2547
Practice Address - Country:US
Practice Address - Phone:707-762-1111
Practice Address - Fax:707-763-9040
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0161160Medicare ID - Type Unspecified