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General NPI Number Information
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NPI Number | 1528882750
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS SPORT AND SPINE
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 8380 WARREN PKWY STE 110
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City | FRISCO
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State | TX
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Zip | 75034-4311
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Country | US
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Telephone | 214-773-0345
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Fax |
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Provider Business Mailing Address
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Address Line | 6030 MILTON ST APT 3114
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City | DALLAS
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State | TX
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Zip | 75206-4439
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Country | US
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Telephone | 214-577-9846
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMUEL GASTON
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Credential | DC
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Telephone | 214-577-9846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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