Provider Demographics
NPI:1003984337
Name:COLLINS, LORI A (CH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-1045
Mailing Address - Country:US
Mailing Address - Phone:276-963-0395
Mailing Address - Fax:
Practice Address - Street 1:305 ALLEGHENY ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2346
Practice Address - Country:US
Practice Address - Phone:276-963-0395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA012714W98Medicare PIN