Healthcare Provider Details

I. General information

NPI: 1487799581
Provider Name (Legal Business Name): THOMAS N COLLINS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIDGE RD
WILMETTE IL
60091-1559
US

IV. Provider business mailing address

901 RIDGE RD
WILMETTE IL
60091-1559
US

V. Phone/Fax

Practice location:
  • Phone: 847-256-9906
  • Fax:
Mailing address:
  • Phone: 847-256-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: