Provider Demographics
NPI:1801078290
Name:GEORGE KYRIOPOULOS
Entity type:Organization
Organization Name:GEORGE KYRIOPOULOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KYRIOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-654-6263
Mailing Address - Street 1:711 W ESLPLANADE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582
Mailing Address - Country:US
Mailing Address - Phone:951-654-6263
Mailing Address - Fax:
Practice Address - Street 1:711 W ESLPLANADE
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582
Practice Address - Country:US
Practice Address - Phone:951-654-6263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0157070111NN0400X, 111NS0005X, 111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0157070Medicaid
CADC0157070Medicaid
CADC0157070Medicare PIN