Healthcare Provider Details

I. General information

NPI: 1689779761
Provider Name (Legal Business Name): JAMES W. GEORGE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MILWAUKEE ST SUITE 230
SAINT LOUIS MO
63122-7356
US

IV. Provider business mailing address

1099 MILWAUKEE ST SUITE 240
SAINT LOUIS MO
63122-7356
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-1502
  • Fax: 314-821-9889
Mailing address:
  • Phone: 314-822-1502
  • Fax: 314-821-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2004010551
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: