Provider Demographics
NPI:1407849326
Name:FIELDS, GENE JAY (DC)
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:JAY
Last Name:FIELDS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 MURTON PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-3762
Mailing Address - Country:US
Mailing Address - Phone:817-514-8436
Mailing Address - Fax:
Practice Address - Street 1:5750 RUFE SNOW DR STE 100
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6140
Practice Address - Country:US
Practice Address - Phone:817-581-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU64607Medicare UPIN