Provider Demographics
NPI:1184638470
Name:BRAD WESLEY COLLINS DC PA
Entity Type:Organization
Organization Name:BRAD WESLEY COLLINS DC PA
Other - Org Name:MIDLOTHIAN SPINE & SPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-723-1155
Mailing Address - Street 1:525 EAST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-2962
Mailing Address - Country:US
Mailing Address - Phone:972-723-1155
Mailing Address - Fax:972-723-1156
Practice Address - Street 1:525 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-2962
Practice Address - Country:US
Practice Address - Phone:972-723-1155
Practice Address - Fax:972-723-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0150PUOtherBCBS
TX0150PUOtherBCBS