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General NPI Number Information
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NPI Number | 1548668528
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Entity Type | Organization
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Legal Business Name | KINETIC WELLNESS CENTER. DR. GEORGE CHIROPRACTIC CORP
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 6940 SANTA TERESA BLVD STE 6
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City | SAN JOSE
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State | CA
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Zip | 95119-1345
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Country | US
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Telephone | 408-429-2888
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Fax | 405-622-4251
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Provider Business Mailing Address
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Address Line | 6940 SANTA TERESA BLVD STE 6
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City | SAN JOSE
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State | CA
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Zip | 95119-1345
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Country | US
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Telephone | 408-429-2888
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Fax | 405-622-4251
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Authorized Official
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Title or Position | OWNER/CEO/MANAGING W-2 EMPLOYEE
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Name | DR. DOUGLAS A GEORGE
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Credential | DC
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Telephone | 408-799-2366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC22678
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License Number State | CA
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