Healthcare Provider Details

I. General information

NPI: 1982930749
Provider Name (Legal Business Name): ALLEN CHIROPRACTIC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 S WESTWOOD BLVD SUITE 5
POPLAR BLUFF MO
63901-6108
US

IV. Provider business mailing address

1018 S WESTWOOD BLVD SUITE 5
POPLAR BLUFF MO
63901-6108
US

V. Phone/Fax

Practice location:
  • Phone: 573-778-0500
  • Fax: 573-778-0160
Mailing address:
  • Phone: 573-778-0500
  • Fax: 573-778-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberCE 6097
License Number StateMO

VIII. Authorized Official

Name: DR. LAURIE M ALLEN
Title or Position: OWNER
Credential: D.C., F.I.A.M.A.
Phone: 573-778-0500