Provider Demographics
NPI:1144889262
Name:LOVELACE, COLBY
Entity type:Individual
Prefix:DR
First Name:COLBY
Middle Name:
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-7591
Mailing Address - Country:US
Mailing Address - Phone:870-598-7054
Mailing Address - Fax:
Practice Address - Street 1:8 OAK TREE VLG
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-1901
Practice Address - Country:US
Practice Address - Phone:573-996-7276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019017072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor