Provider Demographics
NPI:1255426094
Name:COLLINS CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:COLLINS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:MADISON
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-745-6494
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-0322
Mailing Address - Country:US
Mailing Address - Phone:540-745-6494
Mailing Address - Fax:540-745-6595
Practice Address - Street 1:346 PARKVIEW RD NE
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-3807
Practice Address - Country:US
Practice Address - Phone:540-745-6494
Practice Address - Fax:540-745-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU69340Medicare UPIN