Provider Demographics
NPI:1104801299
Name:COLLINS, GALEN RAY (DC)
Entity type:Individual
Prefix:DR
First Name:GALEN
Middle Name:RAY
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:PO BOX 1215
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-1011
Mailing Address - Country:US
Mailing Address - Phone:704-843-5045
Mailing Address - Fax:704-843-5046
Practice Address - Street 1:526 N BROOME ST
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7376
Practice Address - Country:US
Practice Address - Phone:704-843-5045
Practice Address - Fax:704-843-5046
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085PWOtherBCBS
NC2457033Medicare ID - Type Unspecified