Healthcare Provider Details

I. General information

NPI: 1346314135
Provider Name (Legal Business Name): JOHN J. COLLINS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 VILLA RD
NEWBERG OR
97132-1882
US

IV. Provider business mailing address

PO BOX 1022
NEWBERG OR
97132-8022
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-0619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3010
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: