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General NPI Number Information
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NPI Number | 1588926091
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Entity Type | Organization
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Legal Business Name | COLLINS CHIROPRACTIC & DIAGNOSTICS
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 903 NW 9TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-4501
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Country | US
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Telephone | 479-254-9355
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Fax | 479-254-9360
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Provider Business Mailing Address
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Address Line | 903 NW 9TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-4501
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Country | US
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Telephone | 479-254-9355
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Fax | 479-254-9360
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON MICHAEL COLLINS
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Credential | D.C.
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Telephone | 479-254-9355
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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 | 1532
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License Number State | AR
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