Healthcare Provider Details

I. General information

NPI: 1639419963
Provider Name (Legal Business Name): BLAKE KALKSTEIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2013
Last Update Date: 11/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E JOPPA RD SUITE 300
TOWSON MD
21286-3150
US

IV. Provider business mailing address

200 E JOPPA RD SUITE 300
TOWSON MD
21286-3150
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-7700
  • Fax: 410-296-7784
Mailing address:
  • Phone: 410-296-7700
  • Fax: 410-296-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS03735
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: