Healthcare Provider Details

I. General information

NPI: 1821079245
Provider Name (Legal Business Name): CHESTER A COLLINS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SISKIYOU AVE
MOUNT SHASTA CA
96067-2540
US

IV. Provider business mailing address

2205 HILLTOP DR #15
REDDING CA
96002-0511
US

V. Phone/Fax

Practice location:
  • Phone: 530-926-1731
  • Fax:
Mailing address:
  • Phone: 530-365-4369
  • Fax: 530-365-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: