Provider Demographics
NPI:1992055107
Name:NEWSOME, EDWARD SMITH JR (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SMITH
Last Name:NEWSOME
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:306 E FULLER DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-3846
Mailing Address - Country:US
Mailing Address - Phone:682-241-4409
Mailing Address - Fax:
Practice Address - Street 1:1829 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1351
Practice Address - Country:US
Practice Address - Phone:817-927-9988
Practice Address - Fax:817-927-9989
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor