Provider Demographics
NPI:1790083624
Name:COLLINS, KYLE M (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:M
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 1:7120 E INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3855
Mailing Address - Country:US
Mailing Address - Phone:480-699-3086
Mailing Address - Fax:480-699-2649
Practice Address - Street 1:7120 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE B
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3855
Practice Address - Country:US
Practice Address - Phone:480-699-3086
Practice Address - Fax:480-699-2649
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor