Healthcare Provider Details

I. General information

NPI: 1306874755
Provider Name (Legal Business Name): AMBER R BLACKFORD D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HIGHLAND SPRINGS AVE SUITE 8
BEAUMONT CA
92223-2550
US

IV. Provider business mailing address

701 HIGHLAND SPRINGS AVE SUITE 8
BEAUMONT CA
92223-2550
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-9183
  • Fax: 951-845-9193
Mailing address:
  • Phone: 951-845-9183
  • Fax: 951-845-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 27013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: