Provider Demographics
NPI:1003807348
Name:ALLEN, ERNEST RANDOLPH JR (DC)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:RANDOLPH
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-0671
Mailing Address - Country:US
Mailing Address - Phone:270-522-3957
Mailing Address - Fax:270-522-9000
Practice Address - Street 1:211 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-9225
Practice Address - Country:US
Practice Address - Phone:270-522-3957
Practice Address - Fax:270-522-9000
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000453Medicaid
KY85000453Medicaid