Provider Demographics
NPI:1841300241
Name:BRETTMANN, GARY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:BRETTMANN
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 1:812 E PARK ROW DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-1757
Mailing Address - Country:US
Mailing Address - Phone:817-548-7927
Mailing Address - Fax:817-548-7927
Practice Address - Street 1:812 E PARK ROW DR
Practice Address - Street 2:SUITE #4
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-1757
Practice Address - Country:US
Practice Address - Phone:817-548-7927
Practice Address - Fax:817-548-7927
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603632Medicare ID - Type Unspecified