MEDICARE: DR. DAVID WALTER COLEMAN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC5953	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265458236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WALTER COLEMAN DC

Provider Business Mailing Address
First Line	:	4200 SOUTH FWY
Second Line	:	602
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1400
Country	:	US
Telephone Number	:	817-923-4357
Fax Number	:	817-923-2063

Provider Business Practice Location Address
First Line	:	4200 SOUTH FWY
Second Line	:	602
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1400
Country	:	US
Telephone Number	:	817-923-4357
Fax Number	:	817-923-2063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	06/17/2011

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