Provider Demographics
NPI:1891980033
Name:DOLAN, COLLIN RICHARD (DC)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:RICHARD
Last Name:DOLAN
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 1:1137 N EOLA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7096
Mailing Address - Country:US
Mailing Address - Phone:630-236-3090
Mailing Address - Fax:630-236-3092
Practice Address - Street 1:1137 N EOLA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-7096
Practice Address - Country:US
Practice Address - Phone:630-236-3090
Practice Address - Fax:630-236-3092
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2233886OtherBC/BS
IL2233886OtherBC/BS