Provider Demographics
NPI:1598899429
Name:ALLEN, DAVID MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:ALLEN
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 1:625 NORTH RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040
Mailing Address - Country:US
Mailing Address - Phone:931-542-9420
Mailing Address - Fax:931-542-9422
Practice Address - Street 1:625 NORTH RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-542-9420
Practice Address - Fax:931-542-9422
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3971789Medicaid
TN4066601OtherBLUE CROSS BLUE SHIELD
TN3971789Medicare ID - Type Unspecified
TN3971789Medicaid