Provider Demographics
NPI:1407106297
Name:COLBY STAUBS D C PA
Entity Type:Organization
Organization Name:COLBY STAUBS D C PA
Other - Org Name:ST PETERSBURG CHIROPRACTIC INJURY & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLBY
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:STAUBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-348-4322
Mailing Address - Street 1:6514 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1330
Mailing Address - Country:US
Mailing Address - Phone:727-519-3757
Mailing Address - Fax:727-369-8822
Practice Address - Street 1:6514 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1330
Practice Address - Country:US
Practice Address - Phone:727-519-3757
Practice Address - Fax:727-369-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTAN DH192ZMedicare PIN