Provider Demographics
NPI:1184753030
Name:HOWARD, GEORGE (DC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:HOWARD
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 1:832 BROADWAY ST N
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-1513
Mailing Address - Country:US
Mailing Address - Phone:715-235-3415
Mailing Address - Fax:715-235-6254
Practice Address - Street 1:832 BROADWAY ST N
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-1513
Practice Address - Country:US
Practice Address - Phone:715-235-3415
Practice Address - Fax:715-235-6254
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38813000Medicaid
WIT62262Medicare UPIN