Healthcare Provider Details

I. General information

NPI: 1710175088
Provider Name (Legal Business Name): DOM COLLINO DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S HURON ST
CHEBOYGAN MI
49721-1979
US

IV. Provider business mailing address

321 S HURON ST
CHEBOYGAN MI
49721-1979
US

V. Phone/Fax

Practice location:
  • Phone: 231-597-2225
  • Fax: 231-597-9565
Mailing address:
  • Phone: 231-597-2225
  • Fax: 231-597-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007207
License Number StateMI

VIII. Authorized Official

Name: DR. DOMINIC D COLLINO
Title or Position: OWNER
Credential: D.O.
Phone: 231-597-2225