Healthcare Provider Details

I. General information

NPI: 1750462503
Provider Name (Legal Business Name): COLLINS CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 4TH ST STE 1
CLOVIS CA
93612-1192
US

IV. Provider business mailing address

555 4TH STREET STE 1
CLOVIS CA
93612
US

V. Phone/Fax

Practice location:
  • Phone: 559-323-5000
  • Fax: 559-323-5525
Mailing address:
  • Phone: 559-323-5000
  • Fax: 559-323-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberDC21924
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC21924
License Number StateCA

VIII. Authorized Official

Name: DR. VICTOR JAY COLLINS
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 559-323-5000