Provider Demographics
NPI:1396752713
Name:GEORGE, CALVIN ROSS (DC)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:ROSS
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 1:190 N SWIFT RD
Mailing Address - Street 2:SUITE S
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1476
Mailing Address - Country:US
Mailing Address - Phone:630-599-0950
Mailing Address - Fax:630-599-0952
Practice Address - Street 1:190 N SWIFT RD
Practice Address - Street 2:SUITE S
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1476
Practice Address - Country:US
Practice Address - Phone:630-599-0950
Practice Address - Fax:630-599-0952
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL002282063OtherBCBS PROVIDER NUMBER