Provider Demographics
NPI:1174741581
Name:COLLIER CHIROPRACTIC AND ACCIDENT REHABILITATION CENTER INC
Entity type:Organization
Organization Name:COLLIER CHIROPRACTIC AND ACCIDENT REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-594-8995
Mailing Address - Street 1:2180 IMMOKALEE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1421
Mailing Address - Country:US
Mailing Address - Phone:239-594-8995
Mailing Address - Fax:239-594-9976
Practice Address - Street 1:2180 IMMOKALEE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1421
Practice Address - Country:US
Practice Address - Phone:239-594-8995
Practice Address - Fax:239-594-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0008293111NR0400X
FLCH0006936111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55472OtherBLUE CROSS BLUE SHIELD
FL55472CMedicare ID - Type Unspecified