Healthcare Provider Details

I. General information

NPI: 1194796276
Provider Name (Legal Business Name): RANDALL LEE ALLEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 S ELLINGTON PKWY
LEWISBURG TN
37091-4319
US

IV. Provider business mailing address

1270 S ELLINGTON PKWY
LEWISBURG TN
37091-4319
US

V. Phone/Fax

Practice location:
  • Phone: 931-359-5687
  • Fax: 931-359-4376
Mailing address:
  • Phone: 931-359-5687
  • Fax: 931-359-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number514
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: