Provider Demographics
NPI:1215200480
Name:COLLETT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:COLLETT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-852-4942
Mailing Address - Street 1:322 MAIN ST
Mailing Address - Street 2:P.O. BOX 476
Mailing Address - City:SHARON SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:67758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHARON SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:67758
Practice Address - Country:US
Practice Address - Phone:785-852-4942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05456261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center