Provider Demographics
NPI:1457475436
Name:COLLINS, CECIL EUGENE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:EUGENE
Last Name:COLLINS
Suffix:JR
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 1:1504 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-5163
Mailing Address - Country:US
Mailing Address - Phone:423-573-1658
Mailing Address - Fax:423-573-1658
Practice Address - Street 1:1504 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-5163
Practice Address - Country:US
Practice Address - Phone:423-573-1658
Practice Address - Fax:423-573-1658
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2345678OtherCOMM
TN3058108OtherBCBS
TN3679189Medicaid
TN3679189Medicaid