Healthcare Provider Details

I. General information

NPI: 1588046262
Provider Name (Legal Business Name): COLBY DEEM CALTRIDER D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 KINGSLEY LAKE DR STE 901
ST AUGUSTINE FL
32092-3048
US

IV. Provider business mailing address

1639 SOUTHSIDE BLVD
JACKSONVILLE FL
32216-1923
US

V. Phone/Fax

Practice location:
  • Phone: 904-999-8343
  • Fax: 904-325-9049
Mailing address:
  • Phone: 904-725-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11232
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 11232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: