Provider Demographics
NPI:1063231330
Name:FAULKNER, GAGE (DC, MS)
Entity type:Individual
Prefix:DR
First Name:GAGE
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 LEMMON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3708
Mailing Address - Country:US
Mailing Address - Phone:469-702-1782
Mailing Address - Fax:
Practice Address - Street 1:4140 LEMMON AVE STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3708
Practice Address - Country:US
Practice Address - Phone:469-702-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor