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General NPI Number Information
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NPI Number | 1679879779
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Entity Type | Organization
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Legal Business Name | GATEWAY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 3250 HULEN ST STE 140
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City | FORT WORTH
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State | TX
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Zip | 76107-8101
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Country | US
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Telephone | 817-886-7545
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Fax | 817-886-0090
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Provider Business Mailing Address
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Address Line | 3250 HULEN ST STE 140
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City | FORT WORTH
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State | TX
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Zip | 76107-8101
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Country | US
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Telephone | 817-886-7545
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Fax | 817-886-0090
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. AARON LEE WALL
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Credential | D.C.
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Telephone | 817-886-7545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 10734
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License Number State | TX
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