Provider Demographics
NPI:1780734525
Name:VILLA, GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:VILLA
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:PO BOX 23452
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-3452
Mailing Address - Country:US
Mailing Address - Phone:254-776-3600
Mailing Address - Fax:254-776-3602
Practice Address - Street 1:611 W STATE HIGHWAY 6 STE 113
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7545
Practice Address - Country:US
Practice Address - Phone:254-776-3600
Practice Address - Fax:254-776-3602
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00201YMedicare ID - Type Unspecified
TXV03896Medicare UPIN