Provider Demographics
NPI:1912022609
Name:COLLINS, STEPHEN JAMES (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAMES
Last Name:COLLINS
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:JAMES
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHIROPRACTOR
Mailing Address - Street 1:533 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3309
Mailing Address - Country:US
Mailing Address - Phone:718-491-4274
Mailing Address - Fax:718-491-4275
Practice Address - Street 1:533 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3309
Practice Address - Country:US
Practice Address - Phone:718-491-4274
Practice Address - Fax:718-491-4275
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor