Provider Demographics
NPI:1770680662
Name:LEBEAU, GEORGE R (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:LEBEAU
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 1:2737 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1551
Mailing Address - Country:US
Mailing Address - Phone:760-726-9669
Mailing Address - Fax:760-726-8865
Practice Address - Street 1:1365 W VISTA WAY STE 100
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6272
Practice Address - Country:US
Practice Address - Phone:760-726-9660
Practice Address - Fax:760-726-8865
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC10902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor