Provider Demographics
NPI:1396112199
Name:COLLIN, STEPHANIE (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:COLLIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 LOWREY PL
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3003
Mailing Address - Country:US
Mailing Address - Phone:860-436-2065
Mailing Address - Fax:860-436-2066
Practice Address - Street 1:123 LOWREY PL
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3003
Practice Address - Country:US
Practice Address - Phone:860-436-2065
Practice Address - Fax:860-436-2066
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7.002020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor