Provider Demographics
NPI:1770603763
Name:AVERY, GEORGE E (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:AVERY
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 1:21 S LOT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4037
Mailing Address - Country:US
Mailing Address - Phone:970-249-2471
Mailing Address - Fax:970-249-2472
Practice Address - Street 1:21 S LOT AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4037
Practice Address - Country:US
Practice Address - Phone:970-249-2471
Practice Address - Fax:970-249-2472
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC18203OtherMEDICARE-PTAN
CO350041035OtherRAILROAD MEDICARE
COM10701OtherWORKERS COMPENSATION
OH28622-09OtherOHIO WORKERS COMPENSATION
CO350041035OtherRAILROAD MEDICARE