Provider Demographics
NPI:1750102927
Name:COLLINS, KEVIN BRADLEY (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRADLEY
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 1:395 BAY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1405
Mailing Address - Country:US
Mailing Address - Phone:518-793-1205
Mailing Address - Fax:518-793-1515
Practice Address - Street 1:395 BAY RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1405
Practice Address - Country:US
Practice Address - Phone:518-793-1205
Practice Address - Fax:518-793-1515
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor