Provider Demographics
NPI:1306039607
Name:PURCELL, WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:PURCELL
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 1:4120 TAMIAMI TRL STE D2
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9241
Mailing Address - Country:US
Mailing Address - Phone:941-625-9970
Mailing Address - Fax:941-627-5355
Practice Address - Street 1:4120 TAMIAMI TRL STE D2
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9241
Practice Address - Country:US
Practice Address - Phone:419-625-9970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0003662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88609OtherBLUE CROSS/BLUE SHIELD
FL381598600Medicaid
FLT55900OtherUPIN
FL88609AMedicare PIN