Healthcare Provider Details

I. General information

NPI: 1104909209
Provider Name (Legal Business Name): RODNEY PAUL GATLIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BOYD COURT
AZLE TX
76020-4804
US

IV. Provider business mailing address

400 BOYD COURT
AZLE TX
76020-4804
US

V. Phone/Fax

Practice location:
  • Phone: 817-444-4357
  • Fax: 817-444-0197
Mailing address:
  • Phone: 817-444-4357
  • Fax: 817-444-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC7139
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: