MEDICARE: DR. KEVIN DEAN ALLEN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	01-04696	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9533	OTHER	KS	PREFERRED PLUS OF KANSAS

General Provider Information

NPI Number	:	1972508166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN DEAN ALLEN DC

Provider Business Mailing Address
First Line	:	215 S ANDOVER RD
Second Line	:	STE E
City	:	ANDOVER
State	:	KS
Zip	:	67002-7919
Country	:	US
Telephone Number	:	316-733-0715
Fax Number	:	316-733-5014

Provider Business Practice Location Address
First Line	:	215 S ANDOVER RD
Second Line	:
City	:	ANDOVER
State	:	KS
Zip	:	67002-7919
Country	:	US
Telephone Number	:	316-733-0715
Fax Number	:	316-733-5014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	06/22/2016

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