Provider Demographics
NPI:1700849320
Name:MICHAEL B COLLINS DC PLC
Entity Type:Organization
Organization Name:MICHAEL B COLLINS DC PLC
Other - Org Name:CHIROPRACTIC USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-598-0988
Mailing Address - Street 1:1451 E WILLIAMS FIELD RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1692
Mailing Address - Country:US
Mailing Address - Phone:480-598-0988
Mailing Address - Fax:480-753-9611
Practice Address - Street 1:1451 E WILLIAMS FIELD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1692
Practice Address - Country:US
Practice Address - Phone:480-598-0988
Practice Address - Fax:480-753-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ7177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ107018Medicare ID - Type Unspecified
AZU65874Medicare UPIN