Provider Demographics
NPI:1265584049
Name:ALLIED CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ALLIED CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-332-6840
Mailing Address - Street 1:1320 E STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-4365
Mailing Address - Country:US
Mailing Address - Phone:419-332-6840
Mailing Address - Fax:419-332-6929
Practice Address - Street 1:1320 E STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-4365
Practice Address - Country:US
Practice Address - Phone:419-332-6840
Practice Address - Fax:419-332-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2207632Medicaid
OH2207632Medicaid