Provider Demographics
NPI:1851646186
Name:COLMAN, LAURA ALEXANDRA (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ALEXANDRA
Last Name:COLMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 HIGHWAY 76
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5395
Mailing Address - Country:US
Mailing Address - Phone:931-919-2691
Mailing Address - Fax:931-919-2690
Practice Address - Street 1:894 HIGHWAY 76
Practice Address - Street 2:SUITE 104
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5395
Practice Address - Country:US
Practice Address - Phone:931-919-2691
Practice Address - Fax:931-919-2690
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2607111N00000X
KY5368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor