Provider Demographics
NPI:1487415600
Name:ATTIYAH, GEORGE J (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:ATTIYAH
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 1:701 N GIBBS ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-4619
Mailing Address - Country:US
Mailing Address - Phone:626-665-6508
Mailing Address - Fax:
Practice Address - Street 1:19900 BEACH BLVD STE A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-3762
Practice Address - Country:US
Practice Address - Phone:714-965-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty