Provider Demographics
NPI:1649359027
Name:COLLINS, KIMBERLY ANN (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CENTRAL E AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-9511
Mailing Address - Country:US
Mailing Address - Phone:763-515-6650
Mailing Address - Fax:763-777-9186
Practice Address - Street 1:116 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-9511
Practice Address - Country:US
Practice Address - Phone:763-515-6650
Practice Address - Fax:763-777-9186
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002915Medicare ID - Type Unspecified
MNU95883Medicare UPIN