Healthcare Provider Details

I. General information

NPI: 1619969839
Provider Name (Legal Business Name): CHARLES COLLINS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

6 POMPTON AVE SUITE 25
CEDAR GROVE NJ
07009-2042
US

IV. Provider business mailing address

6 POMPTON AVE SUITE 25
CEDAR GROVE NJ
07009-2042
US

V. Phone/Fax

Practice location:
  • Phone: 973-239-0262
  • Fax: 973-239-8990
Mailing address:
  • Phone: 973-239-0262
  • Fax: 973-857-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00220100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: