MEDICARE: DR. STEPHEN JAMES COLLINS CHIROPRACTOR

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	X004692	NY

General Provider Information

NPI Number	:	1912022609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JAMES COLLINS CHIROPRACTOR

Provider Business Mailing Address
First Line	:	533 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3309
Country	:	US
Telephone Number	:	718-491-4274
Fax Number	:	718-491-4275

Provider Business Practice Location Address
First Line	:	533 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3309
Country	:	US
Telephone Number	:	718-491-4274
Fax Number	:	718-491-4275

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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