Individual
MR. EDWARD LEE CHISHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
4200 COUNTRY DAY LN, FORT WORTH, TX 76109-4201
(817) 302-3200
(817) 302-3279
Mailing address
1705 CARLETON AVE, FORT WORTH, TX 76107-3857
(817) 732-8280
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0929
TX
Other
Enumeration date
03/23/2007
Last updated
07/08/2007
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