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General NPI Number Information
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NPI Number | 1053662353
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Entity Type | Organization
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Legal Business Name | THOMAS M. COLLINS CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 1212 FARMERS LN SUITE 2
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City | SANTA ROSA
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State | CA
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Zip | 95405-6747
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Country | US
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Telephone | 707-566-7396
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Fax | 707-566-7398
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Provider Business Mailing Address
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Address Line | 1212 FARMERS LN SUITE 2
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City | SANTA ROSA
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State | CA
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Zip | 95405-6747
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Country | US
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Telephone | 707-566-7396
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Fax | 707-566-7398
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Authorized Official
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Title or Position | DR./OWNER
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Name | DR. THOMAS MICHAEL COLLINS
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Credential | DC
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Telephone | 707-566-7396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DC17656
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License Number State | CA
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