Provider Demographics
NPI:1811161110
Name:DOOLIN, GEORGE GREGORY (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GREGORY
Last Name:DOOLIN
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 1:2600 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7159
Mailing Address - Country:US
Mailing Address - Phone:563-556-8890
Mailing Address - Fax:563-556-8848
Practice Address - Street 1:2600 DODGE ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7159
Practice Address - Country:US
Practice Address - Phone:563-556-8890
Practice Address - Fax:563-556-8848
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0178509Medicaid
IA41718Medicare PIN
IA0178509Medicaid