Healthcare Provider Details

I. General information

NPI: 1649381914
Provider Name (Legal Business Name): AZLE CHIROPRACTIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/11/2008
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: DR. RODNEY PAUL GATLIN
Title or Position: PRESIDENT OWNER
Credential: DC
Phone: 817-444-4357