Provider Demographics
NPI:1669516886
Name:GEORGE, KARL G (DC LAC)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:G
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3832
Mailing Address - Country:US
Mailing Address - Phone:631-751-0900
Mailing Address - Fax:631-751-0901
Practice Address - Street 1:375 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3832
Practice Address - Country:US
Practice Address - Phone:631-751-0900
Practice Address - Fax:631-751-0901
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002340111N00000X
NY001024171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52055Medicare UPIN
NYX13702Medicare PIN