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General NPI Number Information
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NPI Number | 1326746777
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Entity Type | Individual
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Provider Name | GEORGI STAMATOV DIMOV DC
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Gender | Male
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 09/24/2023
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Provider Practice Location Address
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Address Line | 5400 S WILLIAMSON BLVD APT 2-201
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City | PORT ORANGE
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State | FL
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Zip | 32128-6531
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Country | US
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Telephone | 571-426-6061
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 S WILLIAMSON BLVD APT 1-214
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City | PORT ORANGE
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State | FL
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Zip | 32128-6502
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Country | US
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Telephone | 571-426-6061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA93347
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH14415
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License Number State | FL
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