MEDICARE: COLLURA WELLNESS CENTER P.C.

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	DC007563L	PA

General Provider Information

NPI Number	:	1598196966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLURA WELLNESS CENTER P.C.

Provider Business Mailing Address
First Line	:	220 CHURCH ST
Second Line	:
City	:	JESSUP
State	:	PA
Zip	:	18434-1049
Country	:	US
Telephone Number	:	570-383-4800
Fax Number	:	570-291-0064

Provider Business Practice Location Address
First Line	:	220 CHURCH ST
Second Line	:
City	:	JESSUP
State	:	PA
Zip	:	18434-1049
Country	:	US
Telephone Number	:	570-383-4800
Fax Number	:	570-291-0064

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRANK COLLURA
Credential	:	D.C.
Telephone Number	:	570-383-4800

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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