Provider Demographics
NPI:1538291018
Name:ALLEN, COLLINS JOHN (MAC, LICAC)
Entity Type:Individual
Prefix:MR
First Name:COLLINS
Middle Name:JOHN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MAC, LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2710
Mailing Address - Country:US
Mailing Address - Phone:617-524-1925
Mailing Address - Fax:
Practice Address - Street 1:81 COREY ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-2338
Practice Address - Country:US
Practice Address - Phone:617-327-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202808171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist