MEDICARE: KARL G GEORGE DC LAC

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	X002340	NY
2	171100000X	Acupuncturist	001024	NY

General Provider Information

NPI Number	:	1669516886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARL G GEORGE DC LAC

Provider Business Mailing Address
First Line	:	375 MAIN STREET
Second Line	:
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-3832
Country	:	US
Telephone Number	:	631-751-0900
Fax Number	:	631-751-0901

Provider Business Practice Location Address
First Line	:	375 MAIN STREET
Second Line	:
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-3832
Country	:	US
Telephone Number	:	631-751-0900
Fax Number	:	631-751-0901

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	11/08/2007

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