Provider Demographics
NPI:1720034952
Name:ALLEN, DANIEL FRED (DC PC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:FRED
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 E PIMA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3314
Mailing Address - Country:US
Mailing Address - Phone:520-318-9841
Mailing Address - Fax:520-318-9845
Practice Address - Street 1:3917 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3314
Practice Address - Country:US
Practice Address - Phone:520-318-9841
Practice Address - Fax:520-318-9845
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0081500OtherBCBS ID
AZ28100185OtherSTATE FUND WORK COMP
AZT41340Medicare UPIN