MEDICARE: TODD RULAND D C P C

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	DC6175	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0023NJ	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1518088624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TODD RULAND D C P C

Provider Business Mailing Address
First Line	:	PO BOX 121309
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76121-1309
Country	:	US
Telephone Number	:	817-498-7333
Fax Number	:	817-581-2866

Provider Business Practice Location Address
First Line	:	3625 WESTERN CENTER BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1936
Country	:	US
Telephone Number	:	817-498-7333
Fax Number	:	817-581-2866

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JIMMY TODD RULAND
Credential	:	D.C.
Telephone Number	:	817-498-7333

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/07/2008

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Practice Location Address:

3625 WESTERN CENTER BLVD
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1922212141 — DR. HECTOR GONZALEZ DO
Practice Location Address:

3645 WESTERN CENTER BLVD
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76137-1936

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Practice Fax:

1295966133 — DR. GIDEON TRAWEEK D.C.
Practice Location Address:

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76137-1936

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1508147299 — SARAH JANE BENTZ LPC-INTERN
Practice Location Address:

3625 WESTERN CENTER BLVD STE 211
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Directions to “TODD RULAND D C P C ” Practice Location

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