Provider Demographics
NPI:1912938002
Name:GITTIBAN, ARSALAN (DC)
Entity Type:Individual
Prefix:
First Name:ARSALAN
Middle Name:
Last Name:GITTIBAN
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 1:2109 S BOWEN RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5922
Mailing Address - Country:US
Mailing Address - Phone:817-261-6100
Mailing Address - Fax:817-460-7550
Practice Address - Street 1:2109 S BOWEN RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-5922
Practice Address - Country:US
Practice Address - Phone:817-261-6100
Practice Address - Fax:817-460-7550
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00574YOtherMEDICARE PIN-GROUP
TX8D3862Medicare PIN
TXV04243Medicare UPIN