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General NPI Number Information
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NPI Number | 1780116582
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Entity Type | Individual
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Provider Name | SAMUEL GASTON D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 12/12/2024
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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 | 4311 ARROWWOOD ST
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City | MESQUITE
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State | TX
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Zip | 75150-4278
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Country | US
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Telephone |
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 13407
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 13407
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License Number State | TX
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