Provider Demographics
NPI:1447457114
Name:DEGEORGE, MICHAEL GERARD (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GERARD
Last Name:DEGEORGE
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 1:1600 SAINT GEORGES AVE
Mailing Address - Street 2:STE 118
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2764
Mailing Address - Country:US
Mailing Address - Phone:732-428-5566
Mailing Address - Fax:732-428-5513
Practice Address - Street 1:1600 SAINT GEORGES AVE
Practice Address - Street 2:STE 118
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2764
Practice Address - Country:US
Practice Address - Phone:732-428-5566
Practice Address - Fax:732-428-5513
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU63506Medicare UPIN
NJ894345Medicare ID - Type Unspecified