Provider Demographics
NPI:1962470120
Name:DOUGLAS, ALLAN (DC)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:DOUGLAS
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:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-0115
Mailing Address - Country:US
Mailing Address - Phone:731-584-5444
Mailing Address - Fax:731-584-4174
Practice Address - Street 1:130 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1618
Practice Address - Country:US
Practice Address - Phone:731-584-5444
Practice Address - Fax:731-584-4174
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U88953Medicare UPIN
3871184Medicare ID - Type Unspecified