Provider Demographics
NPI:1356392765
Name:ALLEN CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ALLEN CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC,CCSP,CKTI
Authorized Official - Phone:360-892-2226
Mailing Address - Street 1:811 NE 112TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4944
Mailing Address - Country:US
Mailing Address - Phone:360-892-2226
Mailing Address - Fax:360-892-1204
Practice Address - Street 1:811 NE 112TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4944
Practice Address - Country:US
Practice Address - Phone:360-892-2226
Practice Address - Fax:360-892-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
350007584OtherRAILROAD MEDICARE
AB10115OtherGROUP MEDICARE
AB10115OtherGROUP MEDICARE
WAAB10327Medicare ID - Type UnspecifiedDOCTOR PERSONAL NUMBER