Provider Demographics
NPI:1477825602
Name:ALLEN CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:ALLEN CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:814-623-9619
Mailing Address - Street 1:444 E PENN ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-1435
Mailing Address - Country:US
Mailing Address - Phone:814-623-9619
Mailing Address - Fax:814-623-1451
Practice Address - Street 1:444 E PENN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-1435
Practice Address - Country:US
Practice Address - Phone:814-623-9619
Practice Address - Fax:814-623-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001602L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0711639Medicaid
PA00022593OtherWORKER'S COMPENSATION
PA0711639Medicaid