Provider Demographics
NPI:1750462503
Name:COLLINS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:COLLINS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-323-5000
Mailing Address - Street 1:555 4TH STREET
Mailing Address - Street 2:STE 1
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612
Mailing Address - Country:US
Mailing Address - Phone:559-323-5000
Mailing Address - Fax:559-323-5525
Practice Address - Street 1:555 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1192
Practice Address - Country:US
Practice Address - Phone:559-323-5000
Practice Address - Fax:559-323-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21924111N00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0219240OtherBLUE SHIELD
CAU36944Medicare UPIN
CADC0219241Medicare ID - Type Unspecified