Individual
GEORGE LYNN BARDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
706 N GRAND CANYON BLVD., WILLIAMS, AZ 86046-2200
(928) 635-9115
(928) 635-9115
Mailing address
706 N GRAND CANYON BLVD, WILLIAMS, AZ 86046-2016
(928) 635-9115
(928) 635-9115
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
898
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
860363015
FED I D #
AZ
Enumeration date
05/31/2007
Last updated
06/07/2012
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