Provider Demographics
NPI:1306958616
Name:PURCELL, JOSHUA K (DC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:K
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 1:1805 DRAGONFLY RANCH LN
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-3301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3315 W CRAIG RD STE 105
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5001
Practice Address - Country:US
Practice Address - Phone:702-636-2843
Practice Address - Fax:702-636-2993
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC7216OtherANTHEM BLUE CROSS AND BLU
NVV37406Medicare ID - Type Unspecified
CC7216OtherANTHEM BLUE CROSS AND BLU