Provider Demographics
NPI:1396868204
Name:COLLINS, PATRICK BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:BRUCE
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 1:784 CHENA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5710
Mailing Address - Country:US
Mailing Address - Phone:417-389-1290
Mailing Address - Fax:
Practice Address - Street 1:104 KUTTER RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3169
Practice Address - Country:US
Practice Address - Phone:907-452-3600
Practice Address - Fax:907-452-3695
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005009949111N00000X
AK483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor