Healthcare Provider Details

I. General information

NPI: 1245769884
Provider Name (Legal Business Name): CHRISTOPHER BLONK DC, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221A NE 104TH AVE STE 205
VANCOUVER WA
98664-4539
US

IV. Provider business mailing address

221A NE 104TH AVE STE 205
VANCOUVER WA
98664-4539
US

V. Phone/Fax

Practice location:
  • Phone: 360-737-9665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH61482616
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: