Provider Demographics
NPI:1790768182
Name:ALLEN, MARK ERICH (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ERICH
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 1:894 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-4350
Mailing Address - Country:US
Mailing Address - Phone:207-699-2226
Mailing Address - Fax:207-699-2229
Practice Address - Street 1:894 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-4350
Practice Address - Country:US
Practice Address - Phone:207-699-2226
Practice Address - Fax:207-699-2229
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEM204600OtherCIGNA
ME352582OtherHARVARD PILGRIM
ME522405696OtherMED NET SYSTEMS
ME177050000Medicaid
ME522405696OtherHEALTH PLANS INC
ME640621OtherUNITED HEALTHCARE
ME2193260OtherFIRST HEALTH CARE SYSTEMS
ME4639291OtherAETNA
ME522405696OtherPRIVATE HEALTHCARE SYSTEM
ME522405696OtherPREFERREDONE ADMIN SERVIC
ME022415OtherANTHEM
MEALME0272Medicare ID - Type UnspecifiedMEDICARE