Provider Demographics
NPI:1346318995
Name:ALLAN, JUDITH E (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:E
Last Name:ALLAN
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 1:5331 SW MACADAM AVE # 258-441
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6104
Mailing Address - Country:US
Mailing Address - Phone:503-636-6600
Mailing Address - Fax:763-400-4767
Practice Address - Street 1:7100 SW HAMPTON ST STE 121A
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8390
Practice Address - Country:US
Practice Address - Phone:503-636-6600
Practice Address - Fax:763-400-4767
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130183Medicare ID - Type Unspecified
ORV02685Medicare UPIN