Provider Demographics
NPI:1568889863
Name:ALLEN, JENNIFER LEE (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2424 VISTA WAY STE 125
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6283
Mailing Address - Country:US
Mailing Address - Phone:646-552-5150
Mailing Address - Fax:442-333-3302
Practice Address - Street 1:2424 VISTA WAY STE 125
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6283
Practice Address - Country:US
Practice Address - Phone:646-552-5150
Practice Address - Fax:442-333-3302
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17744171100000X, 171100000X
NY27-023248225700000X
CA78835225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist