Provider Demographics
NPI:1255612461
Name:ALLEN, MICAH MARAHIA JACKSON (ACUPUNCTURIST)
Entity type:Individual
Prefix:MRS
First Name:MICAH
Middle Name:MARAHIA JACKSON
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 WADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4525
Mailing Address - Country:US
Mailing Address - Phone:804-464-3315
Mailing Address - Fax:866-398-5292
Practice Address - Street 1:235 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4525
Practice Address - Country:US
Practice Address - Phone:804-464-3315
Practice Address - Fax:866-398-5292
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist