Healthcare Provider Details

I. General information

NPI: 1881168797
Provider Name (Legal Business Name): MARC CHRISTOPHER BLANKENSHIP DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 W PINHOOK RD STE 100
LAFAYETTE LA
70508-8310
US

IV. Provider business mailing address

1904 W PINHOOK RD STE 100
LAFAYETTE LA
70508-8310
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-3720
  • Fax:
Mailing address:
  • Phone: 337-235-3720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2082
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: