Provider Demographics
NPI:1164548632
Name:ALLEN, JOHN MAURICE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MAURICE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:32150 RAILROAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9212
Mailing Address - Country:US
Mailing Address - Phone:951-244-6566
Mailing Address - Fax:951-244-2033
Practice Address - Street 1:32150 RAILROAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-9212
Practice Address - Country:US
Practice Address - Phone:951-244-6566
Practice Address - Fax:951-244-2033
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0137280Medicare UPIN