Healthcare Provider Details

I. General information

NPI: 1689627929
Provider Name (Legal Business Name): PATRICIA A. COLLINS D.C., D.A.B.C.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 MAIN ST
BRIDGEPORT CT
06606-1820
US

IV. Provider business mailing address

4444 MAIN ST
BRIDGEPORT CT
06606-1820
US

V. Phone/Fax

Practice location:
  • Phone: 203-374-4393
  • Fax: 203-371-8584
Mailing address:
  • Phone: 203-374-4393
  • Fax: 203-371-8584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number909
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: