Healthcare Provider Details

I. General information

NPI: 1811345226
Provider Name (Legal Business Name): DR. CHERYL BLANKENSHIP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 SACHEM ST
NORWICH CT
06360-4131
US

IV. Provider business mailing address

148 SACHEM ST
NORWICH CT
06360-4131
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-2882
  • Fax: 860-886-6886
Mailing address:
  • Phone: 860-886-2882
  • Fax: 860-886-6886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001644
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000494
License Number StateCT

VIII. Authorized Official

Name: DR. CHERYL CHAO BLANKENSHIP
Title or Position: PRESIDENT
Credential: D.C., L.AC.
Phone: 860-886-2882