Provider Demographics
NPI:1497711725
Name:COLLINS, RONALD PAUL
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:PAUL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:P
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:300 NEW RIVER PKWY
Mailing Address - Street 2:SUITE 22
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-4450
Mailing Address - Country:US
Mailing Address - Phone:843-208-3404
Mailing Address - Fax:843-208-3405
Practice Address - Street 1:300 NEW RIVER PKWY
Practice Address - Street 2:SUITE 22
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4547
Practice Address - Country:US
Practice Address - Phone:843-208-3404
Practice Address - Fax:843-208-3405
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1697Medicaid
SC311133277OtherBCBS FEDERAL ID
T47018Medicare UPIN
SCCH1697Medicaid