Provider Demographics
NPI:1811914823
Name:STAKER, GEORGE MARTIN (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MARTIN
Last Name:STAKER
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 1:8841 OHIO RIVER RD
Mailing Address - Street 2:WHEELERSBURG CHIROPRACTIC CLINIC
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694
Mailing Address - Country:US
Mailing Address - Phone:740-574-4007
Mailing Address - Fax:740-574-8624
Practice Address - Street 1:8841 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694
Practice Address - Country:US
Practice Address - Phone:740-574-4007
Practice Address - Fax:740-574-8624
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0704698Medicaid
OHST0617542Medicare ID - Type Unspecified
OH0704698Medicaid