Provider Demographics
NPI:1477742153
Name:COLLINS CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:COLLINS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-923-0151
Mailing Address - Street 1:552 BESSEMER RD
Mailing Address - Street 2:
Mailing Address - City:MIDFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35228-3002
Mailing Address - Country:US
Mailing Address - Phone:205-923-0151
Mailing Address - Fax:205-923-3013
Practice Address - Street 1:552 BESSEMER RD
Practice Address - Street 2:
Practice Address - City:MIDFIELD
Practice Address - State:AL
Practice Address - Zip Code:35228-3002
Practice Address - Country:US
Practice Address - Phone:205-923-0151
Practice Address - Fax:205-923-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL71234OtherBC/BS AL
ALUO2663Medicare UPIN
AL71234OtherBC/BS AL