Provider Demographics
NPI:1194723064
Name:KOLLAR, DUSTIN SCOTT (DC)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:SCOTT
Last Name:KOLLAR
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 1:156 SE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4161
Mailing Address - Country:US
Mailing Address - Phone:503-681-8125
Mailing Address - Fax:503-681-8739
Practice Address - Street 1:156 SE 4TH AVE.
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4161
Practice Address - Country:US
Practice Address - Phone:503-681-8125
Practice Address - Fax:503-681-8739
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117588Medicare ID - Type Unspecified