Provider Demographics
NPI:1205177557
Name:ALLEN, NICKOLAS ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:ANTHONY
Last Name:ALLEN
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 1:4206 W 24TH AVE
Mailing Address - Street 2:APT A102
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-9311
Mailing Address - Country:US
Mailing Address - Phone:509-591-4481
Mailing Address - Fax:509-591-4480
Practice Address - Street 1:4206 W 24TH AVE
Practice Address - Street 2:APT A102
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-9311
Practice Address - Country:US
Practice Address - Phone:509-591-4481
Practice Address - Fax:509-591-4480
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60337052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor