Healthcare Provider Details

I. General information

NPI: 1073547576
Provider Name (Legal Business Name): GEORGE GEORGEKOPOULOS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 WAKEFIELD RUN BLVD
HINCKLEY OH
44233-9222
US

IV. Provider business mailing address

204 WAKEFIELD RUN BLVD
HINCKLEY OH
44233-9222
US

V. Phone/Fax

Practice location:
  • Phone: 330-705-0860
  • Fax:
Mailing address:
  • Phone: 330-705-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2850
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: