Healthcare Provider Details

I. General information

NPI: 1205168630
Provider Name (Legal Business Name): KENNETH COLLADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10013 N FLORIDA AVE
TAMPA FL
33612-7410
US

IV. Provider business mailing address

10013 N FLORIDA AVE
TAMPA FL
33612-7410
US

V. Phone/Fax

Practice location:
  • Phone: 813-443-4545
  • Fax: 813-443-4542
Mailing address:
  • Phone: 813-443-4545
  • Fax: 813-443-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberMM23949
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberMM 23949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: