Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3762 | AZ |
NPI | 1003090671 |
---|---|
Provider Name | Dr. Charles Edward St George III |
First Address | Cottonwood, AZ 86326 |
Second Address | Cottonwood, AZ 86326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2007 |
Last Update Date | 29/08/2012 |