Provider Demographics
NPI:1114062403
Name:COLLINS, NORMAN E (DC)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:E
Last Name:COLLINS
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 1:130 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-3533
Mailing Address - Country:US
Mailing Address - Phone:360-426-3787
Mailing Address - Fax:360-426-3787
Practice Address - Street 1:130 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3533
Practice Address - Country:US
Practice Address - Phone:360-426-3787
Practice Address - Fax:360-426-3787
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT91047Medicare UPIN