Physician Compare National (NPI:1134356637)

HEALTHCARE PROVIDER: BLAKE OVERLY DC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1134356637
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5799821914
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091001000355
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	OVERLY
	Individual professional last name
Provider First Name	BLAKE
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CLEVELAND CHIROPRACTIC COLLEGE - KANSAS CITY
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	8002 N OAK TRFY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 112
	Group Practice or individual's line 2 address
City	KANSAS CITY
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	641181272
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y