Healthcare Provider Details

I. General information

NPI: 1891836839
Provider Name (Legal Business Name): COLLINS CHIROPRACTIC PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S LAKE AVE SUITE 230
PASADENA CA
91101-3530
US

IV. Provider business mailing address

350 S LAKE AVE SUITE 230
PASADENA CA
91101-3530
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-8314
  • Fax:
Mailing address:
  • Phone: 626-449-8314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC11183
License Number StateCA

VIII. Authorized Official

Name: DR. E. WAYNE COLLINS
Title or Position: DOCTOR
Credential: D.C.
Phone: 626-449-8314