Provider Demographics
NPI:1073623195
Name:COLLARD, JAMES ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:COLLARD
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:535 ALLEN ST
Mailing Address - Street 2:SUITE 2 SPRINGFIELD CHIROPRACTIC SPORTS REHAB CTR LLP
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2067
Mailing Address - Country:US
Mailing Address - Phone:413-731-5004
Mailing Address - Fax:413-734-6550
Practice Address - Street 1:535 ALLEN ST
Practice Address - Street 2:SUITE 2 SPRINGFIELD CHIROPRACTIC SPORTS REHAB CTR LLP
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-2067
Practice Address - Country:US
Practice Address - Phone:413-731-5004
Practice Address - Fax:413-734-6550
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1609858Medicaid
MACOLY45019Medicare ID - Type Unspecified