Provider Demographics
NPI:1588046262
Name:CALTRIDER, COLBY DEEM (DC)
Entity type:Individual
Prefix:DR
First Name:COLBY
Middle Name:DEEM
Last Name:CALTRIDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 SOUTHSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1923
Mailing Address - Country:US
Mailing Address - Phone:904-725-2286
Mailing Address - Fax:
Practice Address - Street 1:309 KINGSLEY LAKE DR STE 901
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3048
Practice Address - Country:US
Practice Address - Phone:904-999-8343
Practice Address - Fax:904-325-9049
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11232111N00000X
FLCH 11232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor