Provider Demographics
NPI:1154549897
Name:ALLEN, MILO DUANE (DC)
Entity type:Individual
Prefix:DR
First Name:MILO
Middle Name:DUANE
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 1:411 E LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4424
Mailing Address - Country:US
Mailing Address - Phone:831-724-7778
Mailing Address - Fax:831-724-1129
Practice Address - Street 1:411 E LAKE AVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4424
Practice Address - Country:US
Practice Address - Phone:831-724-7778
Practice Address - Fax:831-724-1129
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC10572111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDMEDOtherDME
CA00001OtherASH PLANS
CASKCA0Medicaid
CA94036OtherBLUE SHIELD
CASRRGAOtherRAILROAD MEDICARE
CA47198OtherBLUIE CROSS
CA94036OtherBLUE SHIELD
CASRRGAOtherRAILROAD MEDICARE