MEDICARE: DR. MATTHEW COLASANTI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5438	KY

General Provider Information

NPI Number	:	1477965424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW COLASANTI D.C.

Provider Business Mailing Address
First Line	:	2626 RING RD STE 102
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-9118
Country	:	US
Telephone Number	:	270-706-4181
Fax Number	:	270-763-8457

Provider Business Practice Location Address
First Line	:	2626 RING RD STE 102
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-9118
Country	:	US
Telephone Number	:	270-706-4181
Fax Number	:	270-763-8457

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	03/07/2018

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