Provider Demographics
NPI:1134186182
Name:GEORGE, DAN G (DC)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:G
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 1:395 N 200 W
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7045
Mailing Address - Country:US
Mailing Address - Phone:801-295-6667
Mailing Address - Fax:801-295-6664
Practice Address - Street 1:395 N 200 W
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7045
Practice Address - Country:US
Practice Address - Phone:801-295-6667
Practice Address - Fax:801-295-6664
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176187-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107000652101OtherIHC
UT28528OtherPEHP
UT107000652101OtherIHC