Provider Demographics
NPI:1952471617
Name:ALLEN, MARK
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3517
Mailing Address - Country:US
Mailing Address - Phone:866-680-2366
Mailing Address - Fax:
Practice Address - Street 1:434 S GREEN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3517
Practice Address - Country:US
Practice Address - Phone:866-680-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4215OtherLICENSE NUMBER
KY000000259315OtherBCBS NUMBER
KY4215OtherLICENSE NUMBER