Healthcare Provider Details

I. General information

NPI: 1942285499
Provider Name (Legal Business Name): GEORGE DURO MISKOVIC D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23100 PACIFIC HWY S STE 201
DES MOINES WA
98198-7281
US

IV. Provider business mailing address

23100 PACIFIC HWY S STE 201
DES MOINES WA
98198-7281
US

V. Phone/Fax

Practice location:
  • Phone: 206-824-9500
  • Fax: 206-824-9654
Mailing address:
  • Phone: 206-824-9500
  • Fax: 206-824-9654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1036
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034290
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-010377
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: