Provider Demographics
NPI:1003842238
Name:SU, ALLEN I-HAN (DC, MAOM)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:I-HAN
Last Name:SU
Suffix:
Gender:M
Credentials:DC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5288 SPRING MOUNTAIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8723
Mailing Address - Country:US
Mailing Address - Phone:702-826-2298
Mailing Address - Fax:702-826-2877
Practice Address - Street 1:5288 SPRING MOUNTAIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8723
Practice Address - Country:US
Practice Address - Phone:702-826-2298
Practice Address - Fax:702-826-2877
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB02011111N00000X
CADC 29177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor