Provider Demographics
NPI:1952967754
Name:COLON VELAZQUEZ, JOHN IMMANUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:IMMANUEL
Last Name:COLON VELAZQUEZ
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 1:409 SUSAN CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1416
Mailing Address - Country:US
Mailing Address - Phone:787-672-5252
Mailing Address - Fax:
Practice Address - Street 1:144 YORK RD # 100
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4521
Practice Address - Country:US
Practice Address - Phone:215-675-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor