MEDICARE: DR. GEORGE HAROLD STOVER III 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	DC008738	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	058708XN3	OTHER	PA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001954841	OTHER	PA	HIGHMARK BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144322330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE HAROLD STOVER III DC

Provider Business Mailing Address
First Line	:	PO BOX 825
Second Line	:
City	:	GREAT BEND
State	:	PA
Zip	:	18821
Country	:	US
Telephone Number	:	570-879-2979
Fax Number	:	570-879-5044

Provider Business Practice Location Address
First Line	:	325 MAIN STREET
Second Line	:
City	:	GREAT BEND
State	:	PA
Zip	:	18821
Country	:	US
Telephone Number	:	570-879-2979
Fax Number	:	570-879-5044

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	04/05/2011

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