MEDICARE: DR. ROBERT THURSTON ALDRIDGE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6628	TX

General Provider Information

NPI Number	:	1255330577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT THURSTON ALDRIDGE D.C.

Provider Business Mailing Address
First Line	:	2401 W PIONEER PKWY
Second Line	:	SUITE 145
City	:	PANTEGO
State	:	TX
Zip	:	76013-6056
Country	:	US
Telephone Number	:	817-299-0200
Fax Number	:	817-299-0207

Provider Business Practice Location Address
First Line	:	2401 W PIONEER PKWY
Second Line	:	SUITE 145
City	:	PANTEGO
State	:	TX
Zip	:	76013-6056
Country	:	US
Telephone Number	:	817-299-0200
Fax Number	:	817-299-0207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/10/2012

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