Provider Demographics
NPI:1487733283
Name:COLLINS, MICHAEL LEE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 STATE ROUTE 60 S
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-9478
Mailing Address - Country:US
Mailing Address - Phone:419-929-8235
Mailing Address - Fax:419-929-0581
Practice Address - Street 1:2546 STATE ROUTE 60 S
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:OH
Practice Address - Zip Code:44851-9478
Practice Address - Country:US
Practice Address - Phone:419-929-8235
Practice Address - Fax:419-929-0581
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0287747Medicaid
OHCO0418471Medicare ID - Type Unspecified