Provider Demographics
NPI:1821079245
Name:COLLINS, CHESTER A (DC)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:A
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 1:2205 HILLTOP DR
Mailing Address - Street 2:#15
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0511
Mailing Address - Country:US
Mailing Address - Phone:530-365-4369
Mailing Address - Fax:530-365-4617
Practice Address - Street 1:108 SISKIYOU AVE
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2540
Practice Address - Country:US
Practice Address - Phone:530-926-1731
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0252280OtherBLUE SHIELD
U70067Medicare UPIN
CADC0252280Medicare ID - Type Unspecified