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General NPI Number Information
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NPI Number | 1588046262
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Entity Type | Individual
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Provider Name | COLBY DEEM CALTRIDER D.C
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Gender | Male
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 309 KINGSLEY LAKE DR STE 901
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3048
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Country | US
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Telephone | 904-999-8343
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Fax | 904-325-9049
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Provider Business Mailing Address
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Address Line | 1639 SOUTHSIDE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1923
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Country | US
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Telephone | 904-725-2286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH11232
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 11232
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License Number State | FL
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