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General NPI Number Information
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NPI Number | 1619193653
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Entity Type | Organization
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Legal Business Name | SOUTH LAKE MEDICAL CENTER INC.
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 213 S. EUCLID AVE.
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City | PASADENA
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State | CA
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Zip | 91101-2717
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Country | US
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Telephone | 626-449-8314
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Fax |
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Provider Business Mailing Address
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Address Line | 213 S. EUCLID AVE.
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City | PASADENA
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State | CA
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Zip | 91101-2717
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Country | US
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Telephone | 626-449-8314
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. EVERETT WAYNE COLLINS
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Credential | D.C.
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Telephone | 626-449-6915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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