Provider Demographics
NPI:1528379187
Name:MCCOLLUM, JERROD HEATH (DC)
Entity Type:Individual
Prefix:
First Name:JERROD
Middle Name:HEATH
Last Name:MCCOLLUM
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 1:1934 CIVIC CIR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1812
Mailing Address - Country:US
Mailing Address - Phone:806-352-1500
Mailing Address - Fax:806-352-1506
Practice Address - Street 1:1934 CIVIC CIR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1812
Practice Address - Country:US
Practice Address - Phone:806-352-1500
Practice Address - Fax:806-352-1506
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor