Provider Demographics
NPI:1104526151
Name:COLONIAL CHIROPRACTIC
Entity type:Organization
Organization Name:COLONIAL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:818-769-1791
Mailing Address - Street 1:11000 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2197
Mailing Address - Country:US
Mailing Address - Phone:818-769-1791
Mailing Address - Fax:818-506-8562
Practice Address - Street 1:11000 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2197
Practice Address - Country:US
Practice Address - Phone:818-769-1791
Practice Address - Fax:818-506-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty