Provider Demographics
NPI:1447495692
Name:DUNCAN M. MCCOLLUM D.C. A CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:DUNCAN M. MCCOLLUM D.C. A CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DUNCAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-459-9990
Mailing Address - Street 1:3555 CLARES ST
Mailing Address - Street 2:SUITE WW
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2556
Mailing Address - Country:US
Mailing Address - Phone:831-459-9990
Mailing Address - Fax:831-475-1802
Practice Address - Street 1:3555 CLARES ST
Practice Address - Street 2:SUITE WW
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2556
Practice Address - Country:US
Practice Address - Phone:831-459-9990
Practice Address - Fax:831-475-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty