Provider Demographics
NPI:1881816239
Name:KOLLE, NEIL FREDERICK (DC)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:FREDERICK
Last Name:KOLLE
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 1:25726 W. CHICAGO
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239
Mailing Address - Country:US
Mailing Address - Phone:313-937-1414
Mailing Address - Fax:313-937-1130
Practice Address - Street 1:25726 W. CHICAGO
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239
Practice Address - Country:US
Practice Address - Phone:313-937-1414
Practice Address - Fax:313-937-1130
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICH820047OtherMCARE
MI950H251720OtherBCBS MI
MI105067OtherSELECT CARE
MI350045169OtherMEDICARE RAILROAD
MIP43640OtherBLUE CARE NETWORK
MIT33714Medicare UPIN
MI0H25172Medicare ID - Type Unspecified