Provider Demographics
NPI:1508807678
Name:ALLEN, KEVIN TROY (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:TROY
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 1:43 N 300 W
Mailing Address - Street 2:SUITE B
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-1524
Mailing Address - Country:US
Mailing Address - Phone:435-986-1021
Mailing Address - Fax:435-986-1041
Practice Address - Street 1:43 N 300 W
Practice Address - Street 2:SUITE B
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-1524
Practice Address - Country:US
Practice Address - Phone:435-986-1021
Practice Address - Fax:435-986-1041
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT58182691202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V04765Medicare UPIN