Provider Demographics
NPI:1245314798
Name:COLLINS, STEPHEN JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17144 EVELETH ST NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE X
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4941
Mailing Address - Country:US
Mailing Address - Phone:763-434-0699
Mailing Address - Fax:763-785-1448
Practice Address - Street 1:443 87TH LN NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-1025
Practice Address - Country:US
Practice Address - Phone:763-785-1448
Practice Address - Fax:763-785-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor