Provider Demographics
NPI:1982930749
Name:ALLEN CHIROPRACTIC WELLNESS CENTER
Entity type:Organization
Organization Name:ALLEN CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FIAMA
Authorized Official - Phone:573-778-0500
Mailing Address - Street 1:1018 S WESTWOOD BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-6108
Mailing Address - Country:US
Mailing Address - Phone:573-778-0500
Mailing Address - Fax:573-778-0160
Practice Address - Street 1:1018 S WESTWOOD BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-6108
Practice Address - Country:US
Practice Address - Phone:573-778-0500
Practice Address - Fax:573-778-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE 6097261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1902020068OtherMEDICARE NPI NUMBER