Provider Demographics
NPI:1043526130
Name:ADAM C COLAVITO DC PA
Entity Type:Organization
Organization Name:ADAM C COLAVITO DC PA
Other - Org Name:COLAVITO CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:COLAVITO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-942-8300
Mailing Address - Street 1:3650 N FEDERAL HWY STE D
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6649
Mailing Address - Country:US
Mailing Address - Phone:954-942-8300
Mailing Address - Fax:954-942-8335
Practice Address - Street 1:3650 N FEDERAL HWY STE D
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6649
Practice Address - Country:US
Practice Address - Phone:954-942-8300
Practice Address - Fax:954-942-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006472111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEF698AMedicare PIN