Provider Demographics
NPI:1497834543
Name:COLLINS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:COLLINS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:C
Authorized Official - Last Name:PREUSS-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-323-5000
Mailing Address - Street 1:555 4TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1192
Mailing Address - Country:US
Mailing Address - Phone:559-323-5000
Mailing Address - Fax:559-323-5525
Practice Address - Street 1:555 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1192
Practice Address - Country:US
Practice Address - Phone:559-323-5000
Practice Address - Fax:559-323-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0210990OtherBLUE SHIELD
CAV01637Medicare UPIN
CADC0210990OtherBLUE SHIELD