=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720205446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLLINS CHIROPRACTIC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 619 SW 152ND ST
-----------------------------------------------------
City | BURIEN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98166-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-242-0998
-----------------------------------------------------
Fax | 206-244-3962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 619 SW 152ND ST
-----------------------------------------------------
City | BURIEN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98166-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-242-0998
-----------------------------------------------------
Fax | 206-244-3962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AARON MICHAEL COLLINS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 206-719-6804
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00034322
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------