Provider Demographics
NPI:1427452960
Name:COLLINS, NORMAN ELLSWORTH II (DC)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:ELLSWORTH
Last Name:COLLINS
Suffix:II
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 1:801 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-7020
Mailing Address - Country:US
Mailing Address - Phone:406-883-4216
Mailing Address - Fax:
Practice Address - Street 1:801 4TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-7020
Practice Address - Country:US
Practice Address - Phone:406-883-4216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60501482111N00000X
MT6178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor