MEDICARE: DR. THOMAS LEON BLAKE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2074	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013075746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS LEON BLAKE D.C.

Provider Business Mailing Address
First Line	:	3199 CARRIAGE CREEK CT
Second Line	:
City	:	HAW RIVER
State	:	NC
Zip	:	27258-9047
Country	:	US
Telephone Number	:	336-261-3113
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 NORTH GREENSBORO STREET
Second Line	:
City	:	LIBERTY
State	:	NC
Zip	:	27298-3203
Country	:	US
Telephone Number	:	336-622-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/24/2007

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