Provider Demographics
NPI:1063599322
Name:COLLINS, DANIEL EDWARD (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:EDWARD
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:P.O. BOX 2948
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678
Mailing Address - Country:US
Mailing Address - Phone:410-414-3345
Mailing Address - Fax:410-414-7520
Practice Address - Street 1:810 SOLOMONS ISLAND RD N
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-414-3345
Practice Address - Fax:410-414-3345
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000373111N00000X
MD01667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM220DEOtherBCBS
R6620001OtherBCBS FEDERAL
R6620001OtherBCBS FEDERAL
070QMedicare PIN
MDM220DEOtherBCBS