Provider Demographics
NPI:1356441075
Name:WITHERSPOON, PRESTEN EARL (DC)
Entity type:Individual
Prefix:DR
First Name:PRESTEN
Middle Name:EARL
Last Name:WITHERSPOON
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:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-1121
Mailing Address - Country:US
Mailing Address - Phone:469-297-8053
Mailing Address - Fax:
Practice Address - Street 1:701 E DEBBIE LN STE 113
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3346
Practice Address - Country:US
Practice Address - Phone:817-592-3664
Practice Address - Fax:817-592-3904
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3769111N00000X
TX10252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor