Healthcare Provider Details

I. General information

NPI: 1144889262
Provider Name (Legal Business Name): DR. COLBY LOVELACE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

8 OAK TREE VLG
DONIPHAN MO
63935-1901
US

IV. Provider business mailing address

1481 CYPRESS AVE
PIGGOTT AR
72454-7591
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-7276
  • Fax:
Mailing address:
  • Phone: 870-598-7054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2019017072
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: