Provider Demographics
NPI:1851336549
Name:COLL, VINCENT SILAS JR (DC)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:SILAS
Last Name:COLL
Suffix:JR
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 1:621 S 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1744
Mailing Address - Country:US
Mailing Address - Phone:618-664-0444
Mailing Address - Fax:618-664-0454
Practice Address - Street 1:621 S 2ND STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1744
Practice Address - Country:US
Practice Address - Phone:618-664-0444
Practice Address - Fax:618-664-0454
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME157319OtherBCBS
MO431738059COLOtherMERCY
IL038010756Medicaid
MO7770521OtherAETNA
MO000031985Medicare ID - Type Unspecified
IL215225Medicare PIN
IL038010756Medicaid