Provider Demographics
NPI:1558540260
Name:COLONIAL CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:COLONIAL CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHONA
Authorized Official - Middle Name:SHERINIKA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-615-8977
Mailing Address - Street 1:1310 W COLONIAL DR STE 21-23
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7139
Mailing Address - Country:US
Mailing Address - Phone:407-849-0444
Mailing Address - Fax:407-841-0037
Practice Address - Street 1:1310 W COLONIAL DR STE 21-23
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7139
Practice Address - Country:US
Practice Address - Phone:407-849-0444
Practice Address - Fax:407-841-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty