Provider Demographics
NPI:1497974612
Name:JEFFREY W. COLLINS, P.C.
Entity Type:Organization
Organization Name:JEFFREY W. COLLINS, P.C.
Other - Org Name:COLLINS CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-357-0001
Mailing Address - Street 1:1772 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-4071
Mailing Address - Country:US
Mailing Address - Phone:847-357-0001
Mailing Address - Fax:
Practice Address - Street 1:1772 W GOLF RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4071
Practice Address - Country:US
Practice Address - Phone:847-357-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003773111NN1001X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37231Medicare UPIN
IL611320Medicare PIN