Provider Demographics
NPI:1548330616
Name:AUSTIN, GEORGE RONALD (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RONALD
Last Name:AUSTIN
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 1:21352 CANCUN
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4951
Mailing Address - Country:US
Mailing Address - Phone:949-454-1187
Mailing Address - Fax:
Practice Address - Street 1:21352 CANCUN
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-4951
Practice Address - Country:US
Practice Address - Phone:949-337-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT03868Medicare UPIN
CADC 10250Medicare ID - Type Unspecified