Provider Demographics
NPI:1104909209
Name:GATLIN, RODNEY PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:PAUL
Last Name:GATLIN
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 1:400 BOYD COURT
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-4804
Mailing Address - Country:US
Mailing Address - Phone:817-444-4357
Mailing Address - Fax:817-444-0197
Practice Address - Street 1:400 BOYD COURT
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-4804
Practice Address - Country:US
Practice Address - Phone:817-444-4357
Practice Address - Fax:817-444-0197
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U64410Medicare UPIN
TX00981N8121M0Medicare ID - Type Unspecified