Provider Demographics
NPI:1750389003
Name:BLACKWELL, GILBERT CHAD (DC, DABCO, NP)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:CHAD
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:DC, DABCO, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 AIRPORT FWY STE 130
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6632
Mailing Address - Country:US
Mailing Address - Phone:817-857-6565
Mailing Address - Fax:817-283-7686
Practice Address - Street 1:1305 AIRPORT FWY STE 130
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6632
Practice Address - Country:US
Practice Address - Phone:817-857-6565
Practice Address - Fax:817-283-7686
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136899363LF0000X
TXDC6524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP136899OtherMEDICAL LICENSE
TX00R26ROtherBCBS
TX00R26ROtherBCBS