Provider Demographics
NPI:1275892283
Name:COLLIE, SCOT ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:ALEXANDER
Last Name:COLLIE
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 1:3000 W MACARTHUR BLVD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6916
Mailing Address - Country:US
Mailing Address - Phone:714-397-5100
Mailing Address - Fax:
Practice Address - Street 1:970 TURTLE CREST DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-1012
Practice Address - Country:US
Practice Address - Phone:714-397-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27733 DC111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition