Provider Demographics
NPI:1962712703
Name:COLGIN CHIROPRACTIC AND BAY AREA LASER CENTER
Entity type:Organization
Organization Name:COLGIN CHIROPRACTIC AND BAY AREA LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COLGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-212-1000
Mailing Address - Street 1:2001 WINWARD WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2469
Mailing Address - Country:US
Mailing Address - Phone:650-212-1000
Mailing Address - Fax:
Practice Address - Street 1:2001 WINWARD WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-2469
Practice Address - Country:US
Practice Address - Phone:650-212-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty