Provider Demographics
NPI:1609828045
Name:COLLETT, SHERRI RENE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:RENE
Last Name:COLLETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CHENOWETH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-9795
Mailing Address - Country:US
Mailing Address - Phone:304-636-9610
Mailing Address - Fax:304-636-1449
Practice Address - Street 1:124 CHENOWETH CREEK RD
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-9795
Practice Address - Country:US
Practice Address - Phone:304-636-9610
Practice Address - Fax:304-636-1449
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001721114OtherBLUE CROSS/ BLUE SHIELD
WV1062966OtherWV WORKERS' COMPENSATION
WVU68844Medicare UPIN
WV4129431Medicare ID - Type Unspecified