Provider Demographics
NPI:1770675878
Name:ALLEN CHIROPRACTIC, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ALLEN CHIROPRACTIC, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, NMD
Authorized Official - Phone:949-855-9629
Mailing Address - Street 1:24002 VIA FABRICANTE STE 501
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3934
Mailing Address - Country:US
Mailing Address - Phone:949-855-9629
Mailing Address - Fax:
Practice Address - Street 1:24002 VIA FABRICANTE STE 501
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3934
Practice Address - Country:US
Practice Address - Phone:949-855-9629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11841111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty