Healthcare Provider Details

I. General information

NPI: 1609916808
Provider Name (Legal Business Name): THOMAS E BLANKENBAKER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 E BELL RD
PHOENIX AZ
85022-2800
US

IV. Provider business mailing address

1727 E BELL RD
PHOENIX AZ
85022-2800
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-7246
  • Fax: 602-494-7246
Mailing address:
  • Phone: 602-867-7246
  • Fax: 602-494-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3164
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: