Provider Demographics
NPI:1962042093
Name:KOLLEN, AMBER (DC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:KOLLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:PATTESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2445 COUNTRY PLACE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1102
Mailing Address - Country:US
Mailing Address - Phone:727-264-6091
Mailing Address - Fax:727-264-6099
Practice Address - Street 1:2445 COUNTRY PLACE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1102
Practice Address - Country:US
Practice Address - Phone:727-264-6091
Practice Address - Fax:727-264-6099
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor