Provider Demographics
NPI:1225018344
Name:COLLAZO, EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:COLLAZO
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 1:1509 W STAN SCHLUETER LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-3679
Mailing Address - Country:US
Mailing Address - Phone:817-320-3733
Mailing Address - Fax:817-478-8405
Practice Address - Street 1:1509 W STAN SCHLUETER LOOP
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-3679
Practice Address - Country:US
Practice Address - Phone:254-680-7774
Practice Address - Fax:254-680-7718
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor