Provider Demographics
NPI:1457415671
Name:BASHTON, GEORGE MARTIN (DC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:MARTIN
Last Name:BASHTON
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 1:1011 ALAMO ST
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-4581
Mailing Address - Country:US
Mailing Address - Phone:830-931-3373
Mailing Address - Fax:830-931-2527
Practice Address - Street 1:1011 ALAMO ST
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-4581
Practice Address - Country:US
Practice Address - Phone:830-931-3373
Practice Address - Fax:830-931-2527
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4316OtherSTATE LICENSE NUMBER
TX601708OtherPROVIDER NUMBER
TX609213Medicare ID - Type UnspecifiedMEDICARE
TXT12104Medicare UPIN