Provider Demographics
NPI:1902444938
Name:COLMENERO, JOHN L (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:COLMENERO
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 1:800 E UNIVERSITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5058
Mailing Address - Country:US
Mailing Address - Phone:520-622-3886
Mailing Address - Fax:520-622-3847
Practice Address - Street 1:800 E UNIVERSITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5058
Practice Address - Country:US
Practice Address - Phone:520-622-3886
Practice Address - Fax:520-622-3847
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor