Provider Demographics
NPI:1154553261
Name:COLON, DAVID (LIC AP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:COLON
Suffix:
Gender:M
Credentials:LIC AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 E SANDPIPER CIR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-2810
Mailing Address - Country:US
Mailing Address - Phone:954-436-7393
Mailing Address - Fax:
Practice Address - Street 1:1440 E SANDPIPER CIR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2810
Practice Address - Country:US
Practice Address - Phone:954-436-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-23
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2535171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41-2272114OtherEIN