Provider Demographics
NPI:1962621300
Name:COLLINS, RANDY RAY (DC)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:RAY
Last Name:COLLINS
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 1:2810 PAA ST STE 4
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4429
Mailing Address - Country:US
Mailing Address - Phone:808-839-7474
Mailing Address - Fax:808-833-4086
Practice Address - Street 1:2810 PAA ST STE 4
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4429
Practice Address - Country:US
Practice Address - Phone:808-839-7474
Practice Address - Fax:808-833-4086
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-173111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000QCBSVMedicare ID - Type Unspecified