Provider Demographics
NPI:1609153022
Name:EAST BAY CHIROPRACTIC HEALTH CENTER DR COLLINS INC
Entity Type:Organization
Organization Name:EAST BAY CHIROPRACTIC HEALTH CENTER DR COLLINS INC
Other - Org Name:EAST BAY CHIROPRACTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-243-2425
Mailing Address - Street 1:2574 APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2237
Mailing Address - Country:US
Mailing Address - Phone:510-243-2425
Mailing Address - Fax:510-243-2428
Practice Address - Street 1:2574 APPIAN WAY
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2237
Practice Address - Country:US
Practice Address - Phone:510-243-2425
Practice Address - Fax:510-243-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0242640111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0242640Medicare UPIN