Provider Demographics
NPI:1013047430
Name:MCCOLLUM, DUNCAN M (DC)
Entity Type:Individual
Prefix:
First Name:DUNCAN
Middle Name:M
Last Name:MCCOLLUM
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 1:3555 CLARES ST
Mailing Address - Street 2:SUITE WW
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2556
Mailing Address - Country:US
Mailing Address - Phone:831-459-9990
Mailing Address - Fax:831-475-1802
Practice Address - Street 1:3555 CLARES ST
Practice Address - Street 2:SUITE WW
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2556
Practice Address - Country:US
Practice Address - Phone:831-459-9990
Practice Address - Fax:831-475-1802
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor