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NPI Code Detail

MEDICARE: DR. BLAKE LAURSEN DC

MEDICARE: DR. BLAKE LAURSEN DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2111N00000XChiropractor2020003790MO

General Provider Information

NPI Number : 1972135341
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BLAKE LAURSEN DC
Provider Business Mailing Address
First Line : 3475 PLYMOUTH RD
Second Line :
City : ANN ARBOR
State : MI
Zip : 48105-2550
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3475 PLYMOUTH RD
Second Line :
City : ANN ARBOR
State : MI
Zip : 48105-2550
Country : US
Telephone Number : 712-299-2383
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2020
Last Update Date : 11/01/2023

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Directions to “ DR. BLAKE LAURSEN DC” Practice Location

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