MEDICARE: DR. BRETT ALLEN FYE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC009194	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	400544	OTHER	PA	UPMC
3	FY1592850	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1699756205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT ALLEN FYE D.C.

Provider Business Mailing Address
First Line	:	1405 E WALTON AVE
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-7111
Country	:	US
Telephone Number	:	814-946-0279
Fax Number	:	814-946-9039

Provider Business Practice Location Address
First Line	:	1405 E WALTON AVE
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-7111
Country	:	US
Telephone Number	:	814-946-0279
Fax Number	:	814-946-9039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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