Healthcare Provider Details

I. General information

NPI: 1770675878
Provider Name (Legal Business Name): ALLEN CHIROPRACTIC, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24002 VIA FABRICANTE STE 501
MISSION VIEJO CA
92691-3934
US

IV. Provider business mailing address

24002 VIA FABRICANTE STE 501
MISSION VIEJO CA
92691-3934
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-9629
  • Fax:
Mailing address:
  • Phone: 949-855-9629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC11841
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC11841
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL D ALLEN
Title or Position: PRESIDENT
Credential: DC, NMD
Phone: 949-855-9629