Healthcare Provider Details

I. General information

NPI: 1780116582
Provider Name (Legal Business Name): SAMUEL GASTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 WARREN PKWY STE 110
FRISCO TX
75034-4311
US

IV. Provider business mailing address

4311 ARROWWOOD ST
MESQUITE TX
75150-4278
US

V. Phone/Fax

Practice location:
  • Phone: 214-773-0345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13407
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number13407
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: