Provider Demographics
NPI:1033564059
Name:JASON T REDLER DC, RYAN ROBINSON DC, PLLC
Entity Type:Organization
Organization Name:JASON T REDLER DC, RYAN ROBINSON DC, PLLC
Other - Org Name:SPORTMED CHIROPRACTIC FORT WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:REDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-439-9890
Mailing Address - Street 1:615 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5450
Mailing Address - Country:US
Mailing Address - Phone:817-439-9890
Mailing Address - Fax:
Practice Address - Street 1:817 TOWNE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1201
Practice Address - Country:US
Practice Address - Phone:817-232-2240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10353111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty