=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669438099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY ARLAND COLLINS D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2006
-----------------------------------------------------
Last Update Date | 05/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6750 W PEORIA AVE STE 119
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85345-9316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-486-8223
-----------------------------------------------------
Fax | 623-486-7666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7043 W CORRINE DR
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85381-5333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-878-8019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4194
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------