NPIMap

Organization Active NPI

Collins Clinic of Chiropractic & Sports Medicine, P.a.

  • Chiropractor
  • Waxhaw, NC
National Provider Identifier
1982702684
Registry record updated Jan 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3181 Issued in NC
Legal business name
COLLINS CLINIC OF CHIROPRACTIC & SPORTS MEDICINE, P.A.
Practice address
526 North Broome Street
Waxhaw, NC 28173-1011
Phone
(704) 843-5045
Fax
(704) 843-5046
NPI assigned
Sep 20, 2006
Last updated
Jan 21, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Galen Ray Collins, D.C.NPI 1104801299
Title
Owner
Phone
(704) 843-5045

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3181 NC Primary

Addresses

Primary practice location

526 North Broome Street
Waxhaw, NC 28173-1011

Mailing address

PO Box 1215
526 North Broome Street
Waxhaw, NC 28173-1011
Phone (704) 843-5045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090217000735 NC Part B Supplier - Clinic/Group Practice 0648266387 Receives reassigned benefits from 2 practitioners
Practice locations: Waxhaw, NC

National Provider Directory

National Provider Directory

Locations

526 N Broome St
Waxhaw, NC 28173
Phone (704) 843-5045

8420 New Town Rd
Ste 102
Waxhaw, NC 28173
Phone (704) 239-2127

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232496000000",
    "number": "1982702684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1215",
            "address_2": "526 NORTH BROOME STREET",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281731011",
            "telephone_number": "704-843-5045",
            "fax_number": "704-843-5046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 NORTH BROOME STREET",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281731011",
            "telephone_number": "704-843-5045",
            "fax_number": "704-843-5046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLINS CLINIC OF CHIROPRACTIC & SPORTS MEDICINE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-01-21",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "GALEN",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-843-5045",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waxhaw, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.