Healthcare Provider Details

I. General information

NPI: 1164509204
Provider Name (Legal Business Name): SETH ALLEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 2ND ST SUITE O
MONUMENT CO
80132-7935
US

IV. Provider business mailing address

PO BOX 2870
MONUMENT CO
80132-3010
US

V. Phone/Fax

Practice location:
  • Phone: 719-487-7372
  • Fax: 719-487-7379
Mailing address:
  • Phone: 719-487-7372
  • Fax: 719-487-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number5512
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: