Provider Demographics
NPI:1336157569
Name:COLLIER, JIM WADE (DO)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:WADE
Last Name:COLLIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60046
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76906-0046
Mailing Address - Country:US
Mailing Address - Phone:325-947-2225
Mailing Address - Fax:325-947-3019
Practice Address - Street 1:4241 SOUTHWEST BLVD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5687
Practice Address - Country:US
Practice Address - Phone:325-947-2225
Practice Address - Fax:325-947-3019
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G7000OtherBLUECROSS/BLUE SHIELD
TX8G7000OtherBLUECROSS/BLUE SHIELD
TXU80359Medicare UPIN