Provider Demographics
NPI:1912444647
Name:ALLEN, CHARLES TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:TYLER
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 KNIGHTS CROSS DR
Mailing Address - Street 2:STE. 5107
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2982
Mailing Address - Country:US
Mailing Address - Phone:210-837-8244
Mailing Address - Fax:
Practice Address - Street 1:818 KNIGHTS CROSS DR
Practice Address - Street 2:STE. 5107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2982
Practice Address - Country:US
Practice Address - Phone:210-837-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor