Provider Demographics
NPI:1811015670
Name:JIM W. COLLIER, DCPA
Entity Type:Organization
Organization Name:JIM W. COLLIER, DCPA
Other - Org Name:SOUTHWEST BACK CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DCPA
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:W
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:325-947-2225
Mailing Address - Street 1:4241 SOUTHWEST BLVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5687
Mailing Address - Country:US
Mailing Address - Phone:325-947-2225
Mailing Address - Fax:325-947-3019
Practice Address - Street 1:4241 SOUTHWEST BLVE STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5687
Practice Address - Country:US
Practice Address - Phone:325-947-2225
Practice Address - Fax:325-947-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00196UMedicare ID - Type Unspecified