Provider Demographics
NPI:1790146835
Name:COLLINS, KYLE (DC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
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 1:5375 N GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49410-8742
Mailing Address - Country:US
Mailing Address - Phone:231-690-2103
Mailing Address - Fax:
Practice Address - Street 1:414 US 10
Practice Address - Street 2:
Practice Address - City:SCOTTVILLE
Practice Address - State:MI
Practice Address - Zip Code:49454
Practice Address - Country:US
Practice Address - Phone:231-757-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor