Provider Demographics
NPI:1538152137
Name:GEORGE, DOUGLAS AARON (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:AARON
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 1:6940 SANTA TERESA BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1345
Mailing Address - Country:US
Mailing Address - Phone:408-429-2888
Mailing Address - Fax:408-622-4251
Practice Address - Street 1:6940 SANTA TERESA BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1345
Practice Address - Country:US
Practice Address - Phone:408-429-2888
Practice Address - Fax:408-622-4251
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-01-07
Deactivation Date:2019-11-20
Deactivation Code:
Reactivation Date:2019-12-27
Provider Licenses
StateLicense IDTaxonomies
CADC22678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0226780Medicare PIN