Provider Demographics
NPI:1598781882
Name:PREDDY, ALLAN GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:GEORGE
Last Name:PREDDY
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 1:921 SHILOH RD
Mailing Address - Street 2:STE A-200
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1431
Mailing Address - Country:US
Mailing Address - Phone:903-581-2776
Mailing Address - Fax:903-581-4035
Practice Address - Street 1:921 SHILOH RD
Practice Address - Street 2:STE A-200
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1431
Practice Address - Country:US
Practice Address - Phone:903-581-2776
Practice Address - Fax:903-581-4035
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K9990OtherBLUECROSS PROVIDER NUMBER
TXC06050859Medicaid
TXC06050859Medicaid
TXU47635Medicare UPIN