Provider Demographics
NPI:1962587584
Name:PAUL, GEORGE PHILIP (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PHILIP
Last Name:PAUL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:131 NEW LONDON TPKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2246
Mailing Address - Country:US
Mailing Address - Phone:860-633-7890
Mailing Address - Fax:860-633-5721
Practice Address - Street 1:78 EASTERN BOULDEVARD
Practice Address - Street 2:SUITE 9
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2246
Practice Address - Country:US
Practice Address - Phone:860-659-9969
Practice Address - Fax:860-659-5651
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2013-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT000892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT35000599Medicare ID - Type Unspecified
CTU14261Medicare UPIN