Provider Demographics
NPI:1043245558
Name:KOLODZIEJ, JAMES MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:KOLODZIEJ
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 1:9371 CYPRESS LAKE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-433-9189
Mailing Address - Fax:239-433-4672
Practice Address - Street 1:9371 CYPRESS LAKE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919
Practice Address - Country:US
Practice Address - Phone:239-433-9189
Practice Address - Fax:239-433-4672
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381550100Medicaid
FL381550100Medicaid
45299Medicare UPIN