Provider Demographics
NPI:1104178102
Name:ALLEN, MICHAEL L (DC, CNIM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DC, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WINNERS CIR N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5012
Mailing Address - Country:US
Mailing Address - Phone:877-977-4630
Mailing Address - Fax:888-242-7469
Practice Address - Street 1:100 WINNERS CIR N
Practice Address - Street 2:SUITE 200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5012
Practice Address - Country:US
Practice Address - Phone:877-977-4630
Practice Address - Fax:888-242-7469
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
2594OtherAMERICAN BOARD OF REGISTRATION OF ELECTROENCEPHALOGRAPHIC AND EVOKED POTENTIAL T