Provider Demographics
NPI:1235978099
Name:COLALUCA, MATHEW JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:JOSEPH
Last Name:COLALUCA
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 1:102 ISLAND ESTATES PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-2205
Mailing Address - Country:US
Mailing Address - Phone:386-569-9246
Mailing Address - Fax:
Practice Address - Street 1:2085 A1A S STE 103
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6505
Practice Address - Country:US
Practice Address - Phone:904-515-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty