Provider Demographics
NPI:1093123804
Name:ALLEN, PEARLINE (DC)
Entity Type:Individual
Prefix:DR
First Name:PEARLINE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 WALTON WAY SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3857
Mailing Address - Country:US
Mailing Address - Phone:718-825-5097
Mailing Address - Fax:
Practice Address - Street 1:130 EAGLE SPRING CT STE 3D
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7274
Practice Address - Country:US
Practice Address - Phone:718-825-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009201111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation