Provider Demographics
NPI:1932320751
Name:ALLEN, LISA K (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9970 E 750 N
Mailing Address - Street 2:
Mailing Address - City:WALKERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46574
Mailing Address - Country:US
Mailing Address - Phone:574-586-7816
Mailing Address - Fax:574-586-7814
Practice Address - Street 1:9970 E 750 N
Practice Address - Street 2:
Practice Address - City:WALKERTON
Practice Address - State:IN
Practice Address - Zip Code:46574
Practice Address - Country:US
Practice Address - Phone:574-586-7816
Practice Address - Fax:574-586-7814
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001929A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000274120OtherANTHEM
IN000000274120OtherANTHEM