Provider Demographics
NPI:1336206325
Name:MCCOLLUM, DAVID MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:MCCOLLUM
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 1:56351 29 PALMS HWY STE C
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2859
Mailing Address - Country:US
Mailing Address - Phone:760-365-8729
Mailing Address - Fax:760-365-8732
Practice Address - Street 1:56351 29 PALMS HWY STE C
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2859
Practice Address - Country:US
Practice Address - Phone:760-365-8729
Practice Address - Fax:760-365-8732
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV00327Medicare UPIN
CADC0285160Medicare PIN