Provider Demographics
NPI:1134835135
Name:COLLINS, LOGAN RAY (DC)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:RAY
Last Name:COLLINS
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 1:2420 E MIDWAY BLVD UNIT E
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-7009
Mailing Address - Country:US
Mailing Address - Phone:303-990-5029
Mailing Address - Fax:
Practice Address - Street 1:2420 E MIDWAY BLVD UNIT E
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80234-7009
Practice Address - Country:US
Practice Address - Phone:303-990-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16377111N00000X
COCHR.0008735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor