Healthcare Provider Details

I. General information

NPI: 1578024485
Provider Name (Legal Business Name): COLLEEN M KILL DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W MICHIGAN AVE
JACKSON MI
49201-1907
US

IV. Provider business mailing address

610 W MICHIGAN AVE
JACKSON MI
49201-1907
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-9101
  • Fax: 517-796-3140
Mailing address:
  • Phone: 517-784-9101
  • Fax: 517-796-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: