Provider Demographics
NPI:1740236074
Name:GARRETT, ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GARRETT
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 1:4747 S HULEN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-292-3553
Mailing Address - Fax:817-292-2575
Practice Address - Street 1:4747 S HULEN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-292-3553
Practice Address - Fax:817-292-2575
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7591OtherBLUE CROSS/BLUE SHEILD
TX8K8137Medicare PIN
TX8A7591OtherBLUE CROSS/BLUE SHEILD