Provider Demographics
NPI:1023454550
Name:GEORGE, RONALD MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MATTHEW
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 1:519 KINGS ROW
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-4064
Mailing Address - Country:US
Mailing Address - Phone:304-208-6261
Mailing Address - Fax:
Practice Address - Street 1:1602 W AVENUE A
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-4080
Practice Address - Country:US
Practice Address - Phone:254-899-2225
Practice Address - Fax:254-778-6491
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX301716YTYOMedicare PIN
TX301716YXZKMedicare PIN