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General NPI Number Information
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NPI Number | 1538400643
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Entity Type | Individual
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Provider Name | C. BLAKE MCDONALD D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2013
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 2425 GRAND AVE SUITE 105
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4180
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Country | US
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Telephone | 970-930-1813
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 GRAND AVE
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4180
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Country | US
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Telephone | 970-930-1813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6785
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License Number State | CO
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