MEDICARE: COLLINS CHIROPRACTIC AND WELLNESS CENTER, PLLC

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	111NN1001X	Nutrition Chiropractor

General Provider Information

NPI Number	:	1861057317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLINS CHIROPRACTIC AND WELLNESS CENTER, PLLC

Provider Business Mailing Address
First Line	:	1772 W GOLF RD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4071
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1772 W GOLF RD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4071
Country	:	US
Telephone Number	:	847-357-0001
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY WILLIAM COLLINS
Credential	:	DC
Telephone Number	:	847-357-0001

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	01/04/2020

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