Provider Demographics
NPI:1649774233
Name:COLON, OMAR JOSE (DC)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:JOSE
Last Name:COLON
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 1:8726 NW 26TH ST STE 16
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1628
Mailing Address - Country:US
Mailing Address - Phone:305-477-7976
Mailing Address - Fax:305-629-9187
Practice Address - Street 1:8726 NW 26TH ST STE 16
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1628
Practice Address - Country:US
Practice Address - Phone:305-477-7976
Practice Address - Fax:305-629-9187
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor