Provider Demographics
NPI:1356401897
Name:ALLEN CHIROPRACTIC ORTHOPEDICS, SC
Entity type:Organization
Organization Name:ALLEN CHIROPRACTIC ORTHOPEDICS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC,DABCO
Authorized Official - Phone:630-522-4060
Mailing Address - Street 1:825 N. CASS AVE.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6401
Mailing Address - Country:US
Mailing Address - Phone:630-522-4060
Mailing Address - Fax:
Practice Address - Street 1:825 N. CASS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6401
Practice Address - Country:US
Practice Address - Phone:630-522-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-618253111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232480OtherBCBS GROUP NUMBER
IL2232480OtherBCBS GROUP NUMBER