Provider Demographics
NPI:1164727061
Name:ALLEN, JUSTIN (DC, FASA)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DC, FASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 NW 128TH ST
Mailing Address - Street 2:120
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7432
Mailing Address - Country:US
Mailing Address - Phone:515-225-2220
Mailing Address - Fax:515-225-2229
Practice Address - Street 1:1250 NW 128TH ST
Practice Address - Street 2:120
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7432
Practice Address - Country:US
Practice Address - Phone:515-225-2220
Practice Address - Fax:515-225-2229
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor