Provider Demographics
NPI:1558508655
Name:ALLEN CHIROPRACTIC CARE INC.
Entity Type:Organization
Organization Name:ALLEN CHIROPRACTIC CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:276-466-2273
Mailing Address - Street 1:PO BOX 16056
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24209-6056
Mailing Address - Country:US
Mailing Address - Phone:276-466-2273
Mailing Address - Fax:276-466-2214
Practice Address - Street 1:1932 LEE HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-1624
Practice Address - Country:US
Practice Address - Phone:276-466-2273
Practice Address - Fax:276-466-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-11
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000489111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA214370OtherANTHEM
VA00300403Medicaid
VA350001026OtherMEDICARE
VA350001026OtherMEDICARE
VA00300403Medicaid