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General NPI Number Information
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NPI Number | 1053787408
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Entity Type | Individual
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Provider Name | TRUC LE DC, ATP
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Gender | Male
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 5930 PLUM ST STE 132
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City | WATAUGA
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State | TX
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Zip | 76148-3470
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Country | US
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Telephone | 817-692-1135
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Fax | 817-692-1135
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Provider Business Mailing Address
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Address Line | 5407 BASSWOOD BLVD STE 101
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City | FORT WORTH
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State | TX
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Zip | 76137-4499
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Country | US
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Telephone | 817-576-4111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 12610
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | 93080
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License Number State | TX
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