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Individual
MR. JOHNNY ALLEN COLEGROVE
Active
Individual
MR. JOHNNY ALLEN COLEGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4217
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001341901
—
TX
01
—
5676121
AETNA
TX
01
—
601744
BCBS
TX
Enumeration date
10/02/2006
Last updated
07/27/2010
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