Provider Demographics
NPI:1427267301
Name:BASTECKI, ALLEN RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:RICHARD
Last Name:BASTECKI
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 1:1113 FASHION RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-9609
Mailing Address - Country:US
Mailing Address - Phone:859-643-6100
Mailing Address - Fax:859-643-6105
Practice Address - Street 1:1113 FASHION RIDGE RD
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-9609
Practice Address - Country:US
Practice Address - Phone:859-643-6100
Practice Address - Fax:859-643-6105
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1110111N00000X
KY4876111N00000X
KY248783111N00000X
IA06323111N00000X
WV1069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100274900Medicaid
KY7100274900Medicaid