Provider Demographics
NPI:1174745178
Name:ALLEN, GILBERT P JR (DC)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:P
Last Name:ALLEN
Suffix:JR
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 1:7388 FENTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8963
Mailing Address - Country:US
Mailing Address - Phone:810-730-5546
Mailing Address - Fax:810-258-2159
Practice Address - Street 1:7388 FENTON RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8963
Practice Address - Country:US
Practice Address - Phone:810-730-5546
Practice Address - Fax:810-258-2159
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556798111N00000X
PADC010226111N00000X
MI2301003028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4532627Medicaid
MI950F315620OtherBLUE CROSS BLUE SHIELD
MI4532627Medicaid
MI383627349Medicare UPIN