Provider Demographics
NPI:1447283338
Name:RULAND, JIMMY T (DC)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:T
Last Name:RULAND
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:PO BOX 121309
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76121-1309
Mailing Address - Country:US
Mailing Address - Phone:817-498-7333
Mailing Address - Fax:817-581-2866
Practice Address - Street 1:3625 WESTERN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1936
Practice Address - Country:US
Practice Address - Phone:817-498-7333
Practice Address - Fax:817-581-2866
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001690901Medicaid
TX8V1250OtherBCBS
TX603851Medicare PIN
TXU40803Medicare UPIN