Provider Demographics
NPI:1265458236
Name:COLEMAN, DAVID WALTER (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WALTER
Last Name:COLEMAN
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 1:4200 SOUTH FWY
Mailing Address - Street 2:602
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-1400
Mailing Address - Country:US
Mailing Address - Phone:817-923-4357
Mailing Address - Fax:817-923-2063
Practice Address - Street 1:4200 SOUTH FWY
Practice Address - Street 2:602
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-1400
Practice Address - Country:US
Practice Address - Phone:817-923-4357
Practice Address - Fax:817-923-2063
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116732201Medicaid
TX116732201Medicaid
8F1853Medicare PIN
U35633Medicare UPIN