Provider Demographics
NPI:1326229030
Name:COLAVITA, ANGELO (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:
Last Name:COLAVITA
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 1:600 ROUTE 70 W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3598
Mailing Address - Country:US
Mailing Address - Phone:856-216-7779
Mailing Address - Fax:856-216-7783
Practice Address - Street 1:600 ROUTE 70 W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3598
Practice Address - Country:US
Practice Address - Phone:856-216-7779
Practice Address - Fax:856-216-7783
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC 05517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor