Provider Demographics
NPI:1629182027
Name:COLAVITO, ADAM CHRISTOPHER (DC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:CHRISTOPHER
Last Name:COLAVITO
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 1:3650 NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-942-8300
Mailing Address - Fax:954-942-8335
Practice Address - Street 1:3650 N FEDERAL HWY
Practice Address - Street 2:SUITE D
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006472111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380225600Medicaid
FL380225600Medicaid
FL22829Medicare ID - Type Unspecified
FL22829ZMedicare PIN