Provider Demographics
NPI:1164509204
Name:ALLEN, SETH (DC)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
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:PO BOX 2870
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-3010
Mailing Address - Country:US
Mailing Address - Phone:719-487-7372
Mailing Address - Fax:719-487-7379
Practice Address - Street 1:325 2ND ST
Practice Address - Street 2:SUITE O
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7935
Practice Address - Country:US
Practice Address - Phone:719-487-7372
Practice Address - Fax:719-487-7379
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5512111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT40849Medicare UPIN
CO530508Medicare ID - Type Unspecified