Provider Demographics
NPI:1114041027
Name:ALLEN, THOMAS J (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:ALLEN
Suffix:
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 1:444 E PENN ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-1435
Mailing Address - Country:US
Mailing Address - Phone:814-623-9619
Mailing Address - Fax:814-623-1451
Practice Address - Street 1:444 E PENN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-1435
Practice Address - Country:US
Practice Address - Phone:814-623-9619
Practice Address - Fax:814-623-1451
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001602L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0711639Medicaid
PA00022593OtherPA WORKERS COMPENSATION
PAAL1351917OtherBLUE CROSS BLUE SHIELD
PAAL179634Medicare ID - Type Unspecified