Provider Demographics
NPI:1184678096
Name:ALLEN, ANDREW WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WILLIAM
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 1:6263 PANORAMA RD
Mailing Address - Street 2:
Mailing Address - City:PANORA
Mailing Address - State:IA
Mailing Address - Zip Code:50216-8701
Mailing Address - Country:US
Mailing Address - Phone:641-755-2321
Mailing Address - Fax:
Practice Address - Street 1:108 N 3RD ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-1320
Practice Address - Country:US
Practice Address - Phone:641-747-8247
Practice Address - Fax:641-747-3947
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14617Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER