Provider Demographics
NPI:1023305505
Name:ANDREA, COLT MITCHELL (DC)
Entity type:Individual
Prefix:DR
First Name:COLT
Middle Name:MITCHELL
Last Name:ANDREA
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 1:2650 MOSLEY RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7503
Mailing Address - Country:US
Mailing Address - Phone:904-600-3426
Mailing Address - Fax:904-800-1432
Practice Address - Street 1:1902 ROGERO RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-4117
Practice Address - Country:US
Practice Address - Phone:904-600-3426
Practice Address - Fax:904-800-1432
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor