Provider Demographics
NPI:1487637815
Name:KOLARIK, MORRIS JOSEPH JR (DC)
Entity type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:JOSEPH
Last Name:KOLARIK
Suffix:JR
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 1:16600 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-2219
Mailing Address - Country:US
Mailing Address - Phone:850-230-1288
Mailing Address - Fax:
Practice Address - Street 1:16600 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-2219
Practice Address - Country:US
Practice Address - Phone:850-230-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC847111N00000X
MI2301004362111N00000X
FLCH 10850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1048Medicare ID - Type Unspecified
SCT25067Medicare UPIN