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General NPI Number Information
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NPI Number | 1083011175
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Entity Type | Organization
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Legal Business Name | NEAL B. BLAXBERG, D.C., LLC
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 7 CHURCH LN SUITE 12
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City | BALTIMORE
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State | MD
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Zip | 21208-3710
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Country | US
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Telephone | 410-484-0666
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Fax | 410-486-0816
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Provider Business Mailing Address
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Address Line | 7 CHURCH LN SUITE 12
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City | BALTIMORE
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State | MD
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Zip | 21208-3710
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Country | US
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Telephone | 410-484-0666
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Fax | 410-486-0816
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. NEAL B. BLAXBERG
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Credential | D.C.
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Telephone | 410-484-0666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 01269
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License Number State | MD
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