Provider Demographics
NPI:1659477248
Name:COLLIAS, ANTHONY SCOTT (DC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:SCOTT
Last Name:COLLIAS
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 1:4710 CHIMNEY DR STE H
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-4841
Mailing Address - Country:US
Mailing Address - Phone:304-965-2458
Mailing Address - Fax:304-965-2258
Practice Address - Street 1:4710 CHIMNEY DR STE H
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-4841
Practice Address - Country:US
Practice Address - Phone:304-965-2458
Practice Address - Fax:304-965-2258
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001722786OtherBC/BS
1042963OtherCIGNA
149986OtherCARELINK
WV2204007-001Medicaid
WV1059093OtherBRICKSTREET
7853274OtherAETNA
149986OtherCARELINK
WV001722786OtherBC/BS