Provider Demographics
NPI:1164619268
Name:EDDIE RETTSTATT DC, PC
Entity Type:Organization
Organization Name:EDDIE RETTSTATT DC, PC
Other - Org Name:FAMILY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RETTSTATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:817-249-6761
Mailing Address - Street 1:8507 HIGHWAY 377 S
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-2561
Mailing Address - Country:US
Mailing Address - Phone:817-249-6761
Mailing Address - Fax:817-249-6780
Practice Address - Street 1:8507 HIGHWAY 377 S
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2561
Practice Address - Country:US
Practice Address - Phone:817-249-6761
Practice Address - Fax:817-249-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1285688945OtherBLUE CROSS BLUE SHIELD