Provider Demographics
NPI:1104941434
Name:GEORGE, ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7744 FAY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4313
Mailing Address - Country:US
Mailing Address - Phone:858-459-0180
Mailing Address - Fax:858-504-0595
Practice Address - Street 1:7744 FAY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4313
Practice Address - Country:US
Practice Address - Phone:858-459-0180
Practice Address - Fax:858-504-0595
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13319111N00000X, 111NR0400X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0133190OtherBLUE SHIELD
CADC13319OtherSTATE LICENSE