Provider Demographics
NPI:1558371054
Name:ALLEN, ELAINE RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:RENEE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELAINE
Other - Middle Name:RENEE
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:960 E 53RD ST
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2613
Mailing Address - Country:US
Mailing Address - Phone:563-391-4927
Mailing Address - Fax:563-391-1612
Practice Address - Street 1:960 E 53RD ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2613
Practice Address - Country:US
Practice Address - Phone:563-391-4927
Practice Address - Fax:563-391-1612
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor