Provider Demographics
NPI:1487772406
Name:ALLEN, STEPHEN L (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:ALLEN
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 1:8106 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6076
Mailing Address - Country:US
Mailing Address - Phone:317-885-1414
Mailing Address - Fax:317-885-1415
Practice Address - Street 1:8106 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6076
Practice Address - Country:US
Practice Address - Phone:317-885-1414
Practice Address - Fax:317-885-1415
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000877A111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000542896OtherANTHEM
IN252460Medicare PIN