Provider Demographics
NPI:1710175088
Name:DOM COLLINO DC PLLC
Entity Type:Organization
Organization Name:DOM COLLINO DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:COLLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-597-2225
Mailing Address - Street 1:321 S HURON ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1979
Mailing Address - Country:US
Mailing Address - Phone:231-597-2225
Mailing Address - Fax:231-597-9565
Practice Address - Street 1:321 S HURON ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1979
Practice Address - Country:US
Practice Address - Phone:231-597-2225
Practice Address - Fax:231-597-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDC007207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P53370Medicare PIN