Provider Demographics
NPI:1740283134
Name:GARLETT, GREGORY DALE (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DALE
Last Name:GARLETT
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 1:1200 KELLER PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3819
Mailing Address - Country:US
Mailing Address - Phone:682-593-7659
Mailing Address - Fax:682-593-7651
Practice Address - Street 1:1200 KELLER PKWY
Practice Address - Street 2:STE 300
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3819
Practice Address - Country:US
Practice Address - Phone:682-593-7659
Practice Address - Fax:682-593-7651
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9311111N00000X
IL038.012265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU99590Medicare UPIN
TX11269542OtherCAQH I.D.
8F21606OtherINDIVIDUAL PTAN
TX606669OtherBCBS PROVIDER ID
TXU99590Medicare UPIN
TX641734OtherUNITED HEALTHCARE