MEDICARE: JOSHUA K. PURCELL D.C.

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	B-917	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC7216	OTHER		ANTHEM BLUE CROSS AND BLU

General Provider Information

NPI Number	:	1306958616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA K. PURCELL D.C.

Provider Business Mailing Address
First Line	:	1805 DRAGONFLY RANCH LN
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-3301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3315 W CRAIG RD STE 105
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-5001
Country	:	US
Telephone Number	:	702-636-2843
Fax Number	:	702-636-2993

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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