Provider Demographics
NPI:1265696512
Name:ALLEN CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:ALLEN CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:318-747-6100
Mailing Address - Street 1:2209 SHED RD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3637
Mailing Address - Country:US
Mailing Address - Phone:318-747-6100
Mailing Address - Fax:318-742-3005
Practice Address - Street 1:2209 SHED RD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3637
Practice Address - Country:US
Practice Address - Phone:318-747-6100
Practice Address - Fax:318-742-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty