MEDICARE: DR. GEORGE VILLA D.C.

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	9045	TX

General Provider Information

NPI Number	:	1780734525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE VILLA D.C.

Provider Business Mailing Address
First Line	:	PO BOX 23452
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76702-3452
Country	:	US
Telephone Number	:	254-776-3600
Fax Number	:	254-776-3602

Provider Business Practice Location Address
First Line	:	611 W STATE HIGHWAY 6 STE 113
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-7545
Country	:	US
Telephone Number	:	254-776-3600
Fax Number	:	254-776-3602

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. GEORGE VILLA D.C.” Practice Location

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