1427035047 NPI number — DR. RICHARD CHARLES ALLEN D.C.

Table of content: THERESA HURLEY CNP (NPI 1689077232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427035047 NPI number — DR. RICHARD CHARLES ALLEN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
RICHARD
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427035047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11217 SANDY CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84094-5319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-916-3332
Provider Business Mailing Address Fax Number:
801-307-0718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11576 S STATE ST STE 1101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRAPER
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84020-7105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-307-0544
Provider Business Practice Location Address Fax Number:
801-307-0718
Provider Enumeration Date:
12/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  350109-1202 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 35010912000001 . This is a "REGENCE BCBSU" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com