Provider Demographics
NPI:1245375765
Name:COLLINS, NORMAN J (DC)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:J
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 1:1963 BETHEL RD SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3108
Mailing Address - Country:US
Mailing Address - Phone:360-876-6888
Mailing Address - Fax:360-876-1670
Practice Address - Street 1:2914 MITCHELL RD SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4428
Practice Address - Country:US
Practice Address - Phone:360-876-6888
Practice Address - Fax:360-876-1670
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2211605Medicaid
WA2211605Medicaid
WAG0000200084Medicare ID - Type Unspecified