Provider Demographics
NPI:1821682386
Name:COLLECTIVE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:COLLECTIVE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-281-2849
Mailing Address - Street 1:1149 STONECREST BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1149 STONECREST BLVD STE 106
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-6604
Practice Address - Country:US
Practice Address - Phone:704-281-2849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty