Provider Demographics
NPI:1619969839
Name:COLLINS, CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
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 1:6 POMPTON AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-2042
Mailing Address - Country:US
Mailing Address - Phone:973-239-0262
Mailing Address - Fax:973-857-9124
Practice Address - Street 1:6 POMPTON AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-2042
Practice Address - Country:US
Practice Address - Phone:973-239-0262
Practice Address - Fax:973-239-8990
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2014-07-28
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00220100111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCO536608Medicare PIN
NJT45741Medicare UPIN
NJCO536608Medicare ID - Type Unspecified