Healthcare Provider Details

I. General information

NPI: 1255595088
Provider Name (Legal Business Name): ROBERT W BLAIR DC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14949 KINSMAN RD
BURTON OH
44021
US

IV. Provider business mailing address

14949 KINSMAN RD. P.O. BOX 182
BURTON OH
44021-0182
US

V. Phone/Fax

Practice location:
  • Phone: 440-834-0009
  • Fax: 440-834-0017
Mailing address:
  • Phone: 440-834-0009
  • Fax: 440-834-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number661
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT W BLAIR
Title or Position: OWNER
Credential: D.C.
Phone: 440-834-0009