Provider Demographics
NPI:1245414705
Name:ALLEN CHIROPRACTIC CARE LC
Entity Type:Organization
Organization Name:ALLEN CHIROPRACTIC CARE LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-986-1021
Mailing Address - Street 1:43 N 300 W STE B
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2571
Mailing Address - Country:US
Mailing Address - Phone:435-986-1021
Mailing Address - Fax:435-986-1041
Practice Address - Street 1:43 N 300 W STE B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-2571
Practice Address - Country:US
Practice Address - Phone:435-986-1021
Practice Address - Fax:435-986-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5818269-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00058154OtherMEDICARE GROUP PIN