Provider Demographics
NPI:1952366866
Name:COLLURA, FRANCIS RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:RICHARD
Last Name:COLLURA
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 1:220 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434-1049
Mailing Address - Country:US
Mailing Address - Phone:570-383-4800
Mailing Address - Fax:570-291-0064
Practice Address - Street 1:220 CHURCH ST
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:PA
Practice Address - Zip Code:18434-1049
Practice Address - Country:US
Practice Address - Phone:570-383-4800
Practice Address - Fax:570-291-0064
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007563L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018297960004Medicaid
PA669657OtherBLUE SHIELD NUMBER
PA043307Medicare ID - Type Unspecified
PA0018297960004Medicaid