MEDICARE: DR. COLLEEN ELIZABETH FORD 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	CH 10387	FL

General Provider Information

NPI Number	:	1760750483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN ELIZABETH FORD D.C.

Provider Business Mailing Address
First Line	:	10910 E STATE ROAD 70
Second Line	:	SUITE 101
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-8406
Country	:	US
Telephone Number	:	941-799-7207
Fax Number	:

Provider Business Practice Location Address
First Line	:	10910 E STATE ROAD 70
Second Line	:	SUITE 101
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-8406
Country	:	US
Telephone Number	:	941-799-7207
Fax Number	:

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

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	06/02/2020

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