Provider Demographics
NPI:1992802615
Name:PALAIOLOGOS, GEORGE (DC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:PALAIOLOGOS
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 1:66 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347
Mailing Address - Country:US
Mailing Address - Phone:508-947-0747
Mailing Address - Fax:508-947-0747
Practice Address - Street 1:66 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347
Practice Address - Country:US
Practice Address - Phone:508-947-0747
Practice Address - Fax:508-947-0747
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
454956OtherTUFTS GROUP
648351OtherUNITED HEALTH
Y39554OtherBCBS GROUP
2594584OtherAETNA
469515OtherTUFTS INDV
MA1697013Medicaid
MA351376OtherHARVARD PILGRIM
B21202501OtherCIGNA
Y36808OtherBLUE CROSS BLUE SHIELD
MAPAY45450Medicare ID - Type Unspecified
648351OtherUNITED HEALTH