Provider Demographics
NPI:1013105550
Name:WALL, AARON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:LEE
Last Name:WALL
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 1:3250 HULEN ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-8100
Mailing Address - Country:US
Mailing Address - Phone:817-886-7545
Mailing Address - Fax:
Practice Address - Street 1:3250 HULEN ST
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-8100
Practice Address - Country:US
Practice Address - Phone:817-773-5953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor