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General NPI Number Information
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NPI Number | 1336441625
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Entity Type | Organization
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Legal Business Name | SANDERS CHIROPRACTIC
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 4712 BOAT CLUB RD
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City | FORT WORTH
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State | TX
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Zip | 76135-2002
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Country | US
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Telephone | 817-237-2930
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Fax | 817-237-4143
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Provider Business Mailing Address
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Address Line | 4712 BOAT CLUB RD
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City | FORT WORTH
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State | TX
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Zip | 76135-2002
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Country | US
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Telephone | 817-237-2930
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Fax | 817-237-4143
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. GARY W SANDERS
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Credential | D.C.
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Telephone | 817-237-2930
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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 | 4758
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License Number State | TX
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