Provider Demographics
NPI:1407824220
Name:COLVIN, MICHAEL LEE (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:COLVIN
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 1:714 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3757
Mailing Address - Country:US
Mailing Address - Phone:850-784-7800
Mailing Address - Fax:
Practice Address - Street 1:714 E 4TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3757
Practice Address - Country:US
Practice Address - Phone:850-784-7800
Practice Address - Fax:850-784-7825
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7828111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology