Provider Demographics
NPI:1902020068
Name:ALLEN, LAURIE M (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2725 N WESTWOOD BLVD
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2346
Mailing Address - Country:US
Mailing Address - Phone:573-778-0500
Mailing Address - Fax:573-778-0160
Practice Address - Street 1:2725 N WESTWOOD BLVD
Practice Address - Street 2:SUITE 5B
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2346
Practice Address - Country:US
Practice Address - Phone:573-778-0500
Practice Address - Fax:573-778-0160
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10132TOtherBLUE CROSS
MO32307Medicare ID - Type Unspecified
MO10132TOtherBLUE CROSS