=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770764458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXAS HEALTH QUEST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2007
-----------------------------------------------------
Last Update Date | 11/21/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6801 RUFE SNOW DR SUITE 308
-----------------------------------------------------
City | WATAUGA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76148-2348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-656-1615
-----------------------------------------------------
Fax | 817-428-0573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6801 RUFE SNOW DR SUITE 308
-----------------------------------------------------
City | WATAUGA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76148-2348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-656-1615
-----------------------------------------------------
Fax | 817-428-0573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ARTHUR MICHAEL GRAY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 817-656-1615
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC4083
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------