Provider Demographics
NPI:1497126536
Name:CHIROPRACTIC CONCIERGE
Entity Type:Organization
Organization Name:CHIROPRACTIC CONCIERGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-582-1403
Mailing Address - Street 1:11443 MARIPOE RD
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-3507
Mailing Address - Country:US
Mailing Address - Phone:828-582-1403
Mailing Address - Fax:813-444-3193
Practice Address - Street 1:11443 MARIPOE RD
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34614-3507
Practice Address - Country:US
Practice Address - Phone:828-582-1403
Practice Address - Fax:813-444-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HY268ZOtherMEDICARE NUMBER