Provider Demographics
NPI:1649381914
Name:AZLE CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:AZLE CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-444-4357
Mailing Address - Street 1:400 BOYD COURT
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-4804
Mailing Address - Country:US
Mailing Address - Phone:817-444-4357
Mailing Address - Fax:817-444-0197
Practice Address - Street 1:400 BOYD COURT
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-4804
Practice Address - Country:US
Practice Address - Phone:817-444-4357
Practice Address - Fax:817-444-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00981NMedicare PIN