Provider Demographics
NPI:1245953660
Name:GEORGE, DYLAN (DC)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:GEORGE
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 1:1591 MEGAN BAY CIR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-2045
Mailing Address - Country:US
Mailing Address - Phone:765-265-9628
Mailing Address - Fax:
Practice Address - Street 1:250 PALM COAST PKWY NE UNIT 504
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8288
Practice Address - Country:US
Practice Address - Phone:386-225-4291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor