Provider Demographics
NPI:1306934708
Name:ALLEN, MARK A (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:A
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2525 CALIFORNIIA ST.
Mailing Address - Street 2:SUITE A&B
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-3671
Mailing Address - Country:US
Mailing Address - Phone:812-376-3621
Mailing Address - Fax:812-376-9150
Practice Address - Street 1:2525 CALIFORNIA ST
Practice Address - Street 2:SUITE A&B
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3678
Practice Address - Country:US
Practice Address - Phone:812-376-3621
Practice Address - Fax:812-376-9150
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000525A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100053080AMedicaid
IN100053080AMedicaid