Healthcare Provider Details

I. General information

NPI: 1548205503
Provider Name (Legal Business Name): ALLEN ADOLPHUS THOMAS III D.C., Q.M.E.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11520 JEFFERSON BLVD STE 214
CULVER CITY CA
90230-6148
US

IV. Provider business mailing address

11520 JEFFERSON BLVD STE 214
CULVER CITY CA
90230-6148
US

V. Phone/Fax

Practice location:
  • Phone: 310-598-0345
  • Fax:
Mailing address:
  • Phone: 310-598-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-30156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: