Provider Demographics
NPI:1861510554
Name:MILLET, ALLAN CHARLES JR (DC)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:CHARLES
Last Name:MILLET
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ALLAN
Other - Middle Name:C
Other - Last Name:MILLET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1150 S DEPOT DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-1374
Mailing Address - Country:US
Mailing Address - Phone:801-621-0270
Mailing Address - Fax:801-393-3011
Practice Address - Street 1:1150 S DEPOT DR
Practice Address - Street 2:SUITE 150
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-1374
Practice Address - Country:US
Practice Address - Phone:801-621-0270
Practice Address - Fax:801-393-3011
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174319-1202111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870477616OtherUT PROVIDER #
UTU41226Medicare UPIN
UT000005810Medicare ID - Type Unspecified