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General NPI Number Information
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NPI Number | 1245314798
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Entity Type | Individual
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Provider Name | STEPHEN JOHN COLLINS DC.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 443 87TH LN NE
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City | BLAINE
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State | MN
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Zip | 55434-1025
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Country | US
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Telephone | 763-785-1448
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Fax | 763-785-0114
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Provider Business Mailing Address
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Address Line | 17144 EVELETH ST NE
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City | HAM LAKE X
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State | MN
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Zip | 55304-4941
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Country | US
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Telephone | 763-434-0699
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Fax | 763-785-1448
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2314
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License Number State | MN
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