Provider Demographics
NPI:1558430603
Name:COLLINS, TIMOTHY C (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:COLLINS
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 1:203 W BOONESLICK RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-1914
Mailing Address - Country:US
Mailing Address - Phone:636-456-1861
Mailing Address - Fax:636-456-5972
Practice Address - Street 1:203 W BOONESLICK RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1914
Practice Address - Country:US
Practice Address - Phone:636-456-1861
Practice Address - Fax:636-456-5972
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCEOO5566111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO44-06100OtherUNITED HEALTHCARE
MO206796OtherHEALTHLINK
MO5066OtherBLUE CROSS
MO32536OtherGHP
MO855861OtherFIRST HEALTH
MO5066OtherBLUE CROSS