Healthcare Provider Details

I. General information

NPI: 1962621300
Provider Name (Legal Business Name): RANDY RAY COLLINS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 PAA ST STE 4
HONOLULU HI
96819-4429
US

IV. Provider business mailing address

2810 PAA ST STE 4
HONOLULU HI
96819-4429
US

V. Phone/Fax

Practice location:
  • Phone: 808-839-7474
  • Fax: 808-833-4086
Mailing address:
  • Phone: 808-839-7474
  • Fax: 808-833-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC-173
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: