Provider Demographics
NPI:1497865190
Name:COLLINS, JOHN BENSON (DC, FASA)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BENSON
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DC, FASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3324
Mailing Address - Country:US
Mailing Address - Phone:704-642-0900
Mailing Address - Fax:704-642-0988
Practice Address - Street 1:138 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3324
Practice Address - Country:US
Practice Address - Phone:704-642-0900
Practice Address - Fax:704-642-0988
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890824AMedicaid
NC2448215AMedicare PIN
NC890824AMedicaid