Provider Demographics
NPI:1689627929
Name:COLLINS, PATRICIA A (DC, DABCO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1820
Mailing Address - Country:US
Mailing Address - Phone:203-374-4393
Mailing Address - Fax:203-371-8584
Practice Address - Street 1:4444 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1820
Practice Address - Country:US
Practice Address - Phone:203-374-4393
Practice Address - Fax:203-371-8584
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT909111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004136182Medicaid
CTU28427Medicare UPIN
CT004136182Medicaid