1912022609 NPI number — DR. STEPHEN JAMES COLLINS CHIROPRACTOR

Table of content: DR. STEPHEN JAMES COLLINS CHIROPRACTOR (NPI 1912022609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912022609 NPI number — DR. STEPHEN JAMES COLLINS CHIROPRACTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
STEPHEN
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
CHIROPRACTOR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
STEPHEN
Provider Other Middle Name:
JAMES
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CHIROPRACTOR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912022609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
533 BAY RIDGE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11209-3309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-491-4274
Provider Business Practice Location Address Fax Number:
718-491-4275
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X004692 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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