Healthcare Provider Details

I. General information

NPI: 1942441845
Provider Name (Legal Business Name): ALBERT DELOY BLANCHARD JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 S MARYLAND PKWY #100
LAS VEGAS NV
89109-5031
US

IV. Provider business mailing address

2851 N TENAYA WAY #103
LAS VEGAS NV
89128-0435
US

V. Phone/Fax

Practice location:
  • Phone: 702-309-4878
  • Fax: 702-577-3334
Mailing address:
  • Phone: 702-309-4878
  • Fax: 702-309-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01319
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: