Healthcare Provider Details

I. General information

NPI: 1831514157
Provider Name (Legal Business Name): EMILY BLAIR D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GOLD AVE SW SUITE 102
ALBUQUERQUE NM
87102-3283
US

IV. Provider business mailing address

7617 COMANCHE RD NE
ALBUQUERQUE NM
87110-2303
US

V. Phone/Fax

Practice location:
  • Phone: 505-948-3773
  • Fax:
Mailing address:
  • Phone: 505-948-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2091
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2091
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2091
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2091
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: