Provider Demographics
NPI:1205031143
Name:ALLEN, SALLY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 N LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1347
Mailing Address - Country:US
Mailing Address - Phone:815-464-8450
Mailing Address - Fax:815-464-8451
Practice Address - Street 1:631 N LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1347
Practice Address - Country:US
Practice Address - Phone:815-464-8450
Practice Address - Fax:815-464-8451
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor