Provider Demographics
NPI:1215916358
Name:RICHARDSON, GEORGE BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BRIAN
Last Name:RICHARDSON
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 1:12615 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9126
Mailing Address - Country:US
Mailing Address - Phone:330-699-9240
Mailing Address - Fax:
Practice Address - Street 1:12615 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-9126
Practice Address - Country:US
Practice Address - Phone:330-699-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0986125Medicaid
OH0986125Medicaid
OH0986125Medicaid