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General NPI Number Information
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NPI Number | 1346440385
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Entity Type | Organization
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Legal Business Name | COLLINS CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 109 E MAIN ST
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City | TISHOMINGO
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State | OK
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Zip | 73460-2337
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Country | US
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Telephone | 580-371-3330
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Fax | 580-371-3694
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Provider Business Mailing Address
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Address Line | PO BOX 280
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City | TISHOMINGO
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State | OK
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Zip | 73460-0280
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Country | US
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Telephone | 580-371-3330
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Fax | 580-371-3694
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Authorized Official
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Title or Position | PARNER
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Name | DR. VICKI SUE COLLINS
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Credential | D.C.
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Telephone | 580-371-3330
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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 | 3025
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License Number State | OK
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