Healthcare Provider Details

I. General information

NPI: 1164539490
Provider Name (Legal Business Name): KENNETH DALE GARRETT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 LONGWORTH DR
PLANO TX
75075-8329
US

IV. Provider business mailing address

1113 LONGWORTH DR
PLANO TX
75075-8329
US

V. Phone/Fax

Practice location:
  • Phone: 972-867-9729
  • Fax: 972-867-9722
Mailing address:
  • Phone: 972-867-9729
  • Fax: 972-867-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number8491
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: