Healthcare Provider Details

I. General information

NPI: 1780377622
Provider Name (Legal Business Name): SARAH I ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 JUNIPERO AVE STE 100
LONG BEACH CA
90814-2214
US

IV. Provider business mailing address

1724 MARGUERITE AVE
CORONA DEL MAR CA
92625-1121
US

V. Phone/Fax

Practice location:
  • Phone: 562-476-1177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: