Provider Demographics
NPI:1114077682
Name:ALLEN, RICKEY L (DC)
Entity Type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:L
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 1:1050 RICHARD D. SAILORS PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5228
Mailing Address - Country:US
Mailing Address - Phone:770-943-8409
Mailing Address - Fax:770-943-8410
Practice Address - Street 1:1050 RICHARD D. SAILORS PKWY
Practice Address - Street 2:ST 200
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-5228
Practice Address - Country:US
Practice Address - Phone:770-943-8409
Practice Address - Fax:770-943-8410
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5030111N00000X
GACHIRO005030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U64897Medicare UPIN
GA35ZCDJKMedicare ID - Type Unspecified