Provider Demographics
NPI:1538288964
Name:SPAUDE, ALLEN R (DC)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:R
Last Name:SPAUDE
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 1:218 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1903
Mailing Address - Country:US
Mailing Address - Phone:262-284-9364
Mailing Address - Fax:262-284-1003
Practice Address - Street 1:218 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1903
Practice Address - Country:US
Practice Address - Phone:262-284-9364
Practice Address - Fax:262-284-1003
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2018-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2207012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38843800Medicaid
T63389Medicare UPIN
WI35224Medicare ID - Type Unspecified
WI38843800Medicaid