Healthcare Provider Details

I. General information

NPI: 1609153022
Provider Name (Legal Business Name): EAST BAY CHIROPRACTIC HEALTH CENTER DR COLLINS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2574 APPIAN WAY
PINOLE CA
94564-2237
US

IV. Provider business mailing address

2574 APPIAN WAY
PINOLE CA
94564-2237
US

V. Phone/Fax

Practice location:
  • Phone: 510-243-2425
  • Fax: 510-243-2428
Mailing address:
  • Phone: 510-243-2425
  • Fax: 510-243-2428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC0242640
License Number StateCA

VIII. Authorized Official

Name: SUSAN E KNAPP
Title or Position: CEO
Credential:
Phone: 510-243-2425