Provider Demographics
NPI:1184707036
Name:COLLARD, CHAD L (DC)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:L
Last Name:COLLARD
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 1:9103 SOUTH 1300 WEST STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088
Mailing Address - Country:US
Mailing Address - Phone:801-569-1141
Mailing Address - Fax:801-569-1171
Practice Address - Street 1:9103 S 1300 W STE 101
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6711
Practice Address - Country:US
Practice Address - Phone:801-569-1141
Practice Address - Fax:801-569-1171
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3691541202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor