Provider Demographics
NPI:1669151890
Name:COLLINS, MYRON (DC)
Entity type:Individual
Prefix:
First Name:MYRON
Middle Name:
Last Name:COLLINS
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 1:6701 W 121ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2034
Mailing Address - Country:US
Mailing Address - Phone:913-379-9550
Mailing Address - Fax:913-643-1775
Practice Address - Street 1:622 US 40 HWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014
Practice Address - Country:US
Practice Address - Phone:816-815-7007
Practice Address - Fax:816-815-7008
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023019915111N00000X
NY29049122300000X
LA5894101Y00000X
LA1234103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes111N00000XChiropractic ProvidersChiropractor
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC236Medicaid
5874OtherHEALTH PARTNERS
568946544OtherBCBS