Provider Demographics
NPI:1912444647
Name:ALLEN, CHARLES TYLER (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:TYLER
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 1:710 E PARK BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8854
Mailing Address - Country:US
Mailing Address - Phone:972-850-1446
Mailing Address - Fax:972-920-3858
Practice Address - Street 1:710 E PARK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8854
Practice Address - Country:US
Practice Address - Phone:972-850-1446
Practice Address - Fax:972-920-3858
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor