Healthcare Provider Details

I. General information

NPI: 1073537759
Provider Name (Legal Business Name): BLAKE WILLIAM PRELIPP DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4728 PARK RD SUITE B
CHARLOTTE NC
28209-3490
US

IV. Provider business mailing address

4728 PARK RD SUITE B
CHARLOTTE NC
28209-3490
US

V. Phone/Fax

Practice location:
  • Phone: 704-527-1020
  • Fax: 704-527-1060
Mailing address:
  • Phone: 704-527-1020
  • Fax: 704-527-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number3413
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: