MEDICARE: DR. CECIL EUGENE COLLINS JR. D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC0000001286	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2345678	OTHER		COMM
2	3058108	OTHER	TN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457475436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CECIL EUGENE COLLINS JR. D.C.

Provider Business Mailing Address
First Line	:	1504 VIRGINIA AVE
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-5163
Country	:	US
Telephone Number	:	423-573-1658
Fax Number	:	423-573-1658

Provider Business Practice Location Address
First Line	:	1504 VIRGINIA AVE
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-5163
Country	:	US
Telephone Number	:	423-573-1658
Fax Number	:	423-573-1658

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/09/2007

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