Provider Demographics
NPI:1427035047
Name:ALLEN, RICHARD CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
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 1:11217 SANDY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5319
Mailing Address - Country:US
Mailing Address - Phone:801-916-3332
Mailing Address - Fax:801-307-0718
Practice Address - Street 1:11576 S STATE ST STE 1101
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7105
Practice Address - Country:US
Practice Address - Phone:801-307-0544
Practice Address - Fax:801-307-0718
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT350109-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT35010912000001OtherREGENCE BCBSU