Provider Demographics
NPI:1194796276
Name:ALLEN, RANDALL LEE (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LEE
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 1:1270 S ELLINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-4319
Mailing Address - Country:US
Mailing Address - Phone:931-359-5687
Mailing Address - Fax:931-359-4376
Practice Address - Street 1:1270 S ELLINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-4319
Practice Address - Country:US
Practice Address - Phone:931-359-5687
Practice Address - Fax:931-359-4376
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3673872Medicaid
TN350026997OtherRR MEDICARE
TN909673OtherCIGNA
TN0061585OtherBCBS OF TN
TN44-40110OtherUNITED HEALTHCARE
TN44-40110OtherUNITED HEALTHCARE
TN909673OtherCIGNA