MEDICARE: GEORGE NICHOLAS KALONTUROS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC26560	CA

General Provider Information

NPI Number	:	1093726242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE NICHOLAS KALONTUROS DC

Provider Business Mailing Address
First Line	:	25 SIERRA VISTA
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94947
Country	:	US
Telephone Number	:	415-892-1884
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 MISSION ROAD
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080
Country	:	US
Telephone Number	:	650-589-4985
Fax Number	:	650-588-8337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	01/22/2010

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