MEDICARE: MR. DUSTIN SCOTT KOLLAR DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3439	OR

General Provider Information

NPI Number	:	1194723064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUSTIN SCOTT KOLLAR DC

Provider Business Mailing Address
First Line	:	156 SE 4TH AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-4161
Country	:	US
Telephone Number	:	503-681-8125
Fax Number	:	503-681-8739

Provider Business Practice Location Address
First Line	:	156 SE 4TH AVE.
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-4161
Country	:	US
Telephone Number	:	503-681-8125
Fax Number	:	503-681-8739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/21/2022

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