Healthcare Provider Details

I. General information

NPI: 1174701783
Provider Name (Legal Business Name): ALLEN MELVIN DEPREY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 A1A SO STE 100
ST AUGUSTINE FL
32080-6523
US

IV. Provider business mailing address

2180 A1A SO STE 100
ST AUGUSTINE FL
32080-6523
US

V. Phone/Fax

Practice location:
  • Phone: 904-471-2225
  • Fax: 904-471-6236
Mailing address:
  • Phone: 904-471-2225
  • Fax: 904-471-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0006235
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: