Provider Demographics
NPI:1063581312
Name:MACHA, ALLEN E (DC)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:E
Last Name:MACHA
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 1:600 NORTH 3RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LACROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6299
Mailing Address - Country:US
Mailing Address - Phone:608-782-6604
Mailing Address - Fax:608-782-6335
Practice Address - Street 1:600 NORTH 3RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6299
Practice Address - Country:US
Practice Address - Phone:608-782-6604
Practice Address - Fax:608-782-6335
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1270012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38815900Medicaid
T62656Medicare UPIN