Provider Demographics
NPI:1740473602
Name:ALLEN, ROBERT WAYNE (DC,CCSP,CKTI)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WAYNE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DC,CCSP,CKTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB10115OtherMEDICARE GROUP
AB10327OtherMEDICARE INDIVIDUAL
1356392765OtherNPI INDIVIDUAL
350007584OtherMEDICARE RAILROAD
T02545OtherUPIN