Provider Demographics
NPI:1073709150
Name:GITTIBAN PA
Entity Type:Organization
Organization Name:GITTIBAN PA
Other - Org Name:PREMIER HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ARSALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GITTIBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-261-6100
Mailing Address - Street 1:2109 S BOWEN RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5922
Mailing Address - Country:US
Mailing Address - Phone:817-261-6100
Mailing Address - Fax:817-460-7550
Practice Address - Street 1:2109 S BOWEN RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-5922
Practice Address - Country:US
Practice Address - Phone:817-261-6100
Practice Address - Fax:817-460-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7849DC261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00574YMedicare PIN
TXV04243Medicare UPIN
TX8D3862Medicare PIN