Provider Demographics
NPI:1790011120
Name:BEHRUE, COLIN OLIVER (DC)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:OLIVER
Last Name:BEHRUE
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 1:421 NORTLAKE BLVD.
Mailing Address - Street 2:SUITE F
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408
Mailing Address - Country:US
Mailing Address - Phone:561-842-2273
Mailing Address - Fax:561-842-1362
Practice Address - Street 1:421 NORTHLAKE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5413
Practice Address - Country:US
Practice Address - Phone:561-842-2273
Practice Address - Fax:561-842-1362
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL009752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor