Provider Demographics
NPI:1174701783
Name:DEPREY, ALLEN MELVIN (DC)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:MELVIN
Last Name:DEPREY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 A1A SO
Mailing Address - Street 2:STE 100
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6523
Mailing Address - Country:US
Mailing Address - Phone:904-471-2225
Mailing Address - Fax:904-471-6236
Practice Address - Street 1:2180 A1A SO
Practice Address - Street 2:STE 100
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6523
Practice Address - Country:US
Practice Address - Phone:904-471-2225
Practice Address - Fax:904-471-6236
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350037467OtherRAILROAD MEDICARE
22575OtherBC/BS
22575OtherBC/BS
FLU05944Medicare UPIN