Provider Demographics
NPI:1780616045
Name:PROTZ, GEORGE JONATHAN (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JONATHAN
Last Name:PROTZ
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 1:3455 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-3001
Mailing Address - Country:US
Mailing Address - Phone:843-756-2220
Mailing Address - Fax:843-756-2221
Practice Address - Street 1:3455 BROAD ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-3001
Practice Address - Country:US
Practice Address - Phone:843-756-2220
Practice Address - Fax:843-756-2221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2901Medicaid
SCCH2901Medicaid
SCAA06178477Medicare ID - Type Unspecified