Provider Demographics
NPI:1588757678
Name:KOLE, DOUGLAS L (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:KOLE
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 1:8578 SWEET MAGNOLIA PL
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4600
Mailing Address - Country:US
Mailing Address - Phone:727-212-1902
Mailing Address - Fax:
Practice Address - Street 1:8578 SWEET MAGNOLIA PL
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-4600
Practice Address - Country:US
Practice Address - Phone:727-212-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4160111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHU458ZMedicare PIN
FLT55683Medicare UPIN