Healthcare Provider Details

I. General information

NPI: 1407889918
Provider Name (Legal Business Name): GEORGE W HEATHCOTE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S MAIN ST STE 1
CHAGRIN FALLS OH
44022-3225
US

IV. Provider business mailing address

1 S MAIN ST SUITE 1
CHAGRIN FALLS OH
44022-3225
US

V. Phone/Fax

Practice location:
  • Phone: 440-893-8800
  • Fax: 440-893-9422
Mailing address:
  • Phone: 440-893-8800
  • Fax: 440-893-9422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2725
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: