1154803781 NPI number — JULIE COLLINSCHIROPRACTIC LLC

Table of content: (NPI 1154803781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154803781 NPI number — JULIE COLLINSCHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JULIE COLLINSCHIROPRACTIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154803781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 927
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29071-0927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-490-7945
Provider Business Mailing Address Fax Number:
803-808-0909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607A S LAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29072-3430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-490-7945
Provider Business Practice Location Address Fax Number:
803-808-0909
Provider Enumeration Date:
08/30/2018

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
LIVINGSTON
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
803-490-7945

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4208 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH4208 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com