MEDICARE: SANDERS CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4758	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB129427	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1770623449	OTHER	TX	NPI FOR SOLE PROPRIETOR

General Provider Information

NPI Number	:	1336441625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDERS CHIROPRACTIC

Provider Business Mailing Address
First Line	:	4712 BOAT CLUB RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2002
Country	:	US
Telephone Number	:	817-237-2930
Fax Number	:	817-237-4143

Provider Business Practice Location Address
First Line	:	4712 BOAT CLUB RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2002
Country	:	US
Telephone Number	:	817-237-2930
Fax Number	:	817-237-4143

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. GARY W SANDERS
Credential	:	D.C.
Telephone Number	:	817-237-2930

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	07/14/2014

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Directions to “SANDERS CHIROPRACTIC ” Practice Location

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