Healthcare Provider Details

I. General information

NPI: 1821727975
Provider Name (Legal Business Name): COLTON PURSCELL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 WINDSOR PL
FORT WORTH TX
76110-1845
US

IV. Provider business mailing address

1913 WINDSOR PL
FORT WORTH TX
76110-1845
US

V. Phone/Fax

Practice location:
  • Phone: 817-994-1104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number15162
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: