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1922685957
NICKOLAS DALE MCCOLLUM
KANSAS CITY, MO
NPI
1922685957
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
208100000X Physical Medicine & Rehabilitation
(Licence: MO 2018001717)
Enumeration Date
2021-03-25
Last Update Date
2021-03-25
Business Address
Mr. NICKOLAS DALE MCCOLLUM PTA
5901 NW 63RD TER STE 50
KANSAS CITY, MO 64151-3431
Phone number: 816-589-6234
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Mailing Address
Mr. NICKOLAS DALE MCCOLLUM PTA
5901 NW 63RD TER STE 50
KANSAS CITY, MO 64151-3431
Phone number: 816-589-6234
Copy
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