Provider Demographics
NPI:1912976192
Name:ALLEN, JAMES R (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
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 1:16 RED BUSH LANE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:230-877-5626
Mailing Address - Fax:203-877-5626
Practice Address - Street 1:16 RED BUSH LANE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:230-877-5626
Practice Address - Fax:203-877-5626
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4050613Medicaid
P520311OtherOXFORD
1020367OtherAMERICAN SPECIALITY
05000V316CT01OtherBCBS
0V4433OtherHEALTHNET
05000V316CT01OtherBCBS
0V4433OtherHEALTHNET