Provider Demographics
NPI:1972725273
Name:DEGEORGE, CHRISTOPHER A (DC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
Last Name:DEGEORGE
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 1:3302 S NEW HOPE RD
Mailing Address - Street 2:SUITE 100 F
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8317
Mailing Address - Country:US
Mailing Address - Phone:704-879-9071
Mailing Address - Fax:704-879-9073
Practice Address - Street 1:3302 S NEW HOPE RD
Practice Address - Street 2:SUITE 100 F
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8317
Practice Address - Country:US
Practice Address - Phone:704-879-9071
Practice Address - Fax:704-879-9073
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3713OtherCHIROPRACTIC LICENSE #
NC0855XOtherBLUE CROSS BLUE SHIELD
NC2459619Medicare PIN