Healthcare Provider Details

I. General information

NPI: 1558508655
Provider Name (Legal Business Name): ALLEN CHIROPRACTIC CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2009
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 LEE HWY
BRISTOL VA
24201-1624
US

IV. Provider business mailing address

PO BOX 16056
BRISTOL VA
24209-6056
US

V. Phone/Fax

Practice location:
  • Phone: 276-466-2273
  • Fax: 276-466-2214
Mailing address:
  • Phone: 276-466-2273
  • Fax: 276-466-2214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104000489
License Number StateVA

VIII. Authorized Official

Name: DR. EARL B ALLEN JR.
Title or Position: PRESIDENT
Credential: DC
Phone: 276-466-2273