Healthcare Provider Details

I. General information

NPI: 1013829795
Provider Name (Legal Business Name): BLAINE TABLER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11691 FALL CREEK RD STE 110
INDIANAPOLIS IN
46256-9448
US

IV. Provider business mailing address

18203 JOHN DIPPEL BLVD APT 201
WESTFIELD IN
46074-0919
US

V. Phone/Fax

Practice location:
  • Phone: 812-890-1047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003634A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: