Provider Demographics
NPI:1154378412
Name:ELLWANGER, GEORGE ARTHUR JR (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ARTHUR
Last Name:ELLWANGER
Suffix:JR
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 1:725 CRANBERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28657-6701
Mailing Address - Country:US
Mailing Address - Phone:828-448-5321
Mailing Address - Fax:
Practice Address - Street 1:725 CRANBERRY ST
Practice Address - Street 2:
Practice Address - City:NEWLAND
Practice Address - State:NC
Practice Address - Zip Code:28657-6701
Practice Address - Country:US
Practice Address - Phone:919-851-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2456988Medicare ID - Type Unspecified