MEDICARE: DR. LINDA A 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	LB007856	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	123532	OTHER	MI	PREFERRED CHOICES
2	CH630035	OTHER	MI	M-CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5260086	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1043260961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA A BLAKE D.C.

Provider Business Mailing Address
First Line	:	1606 STANLEY AVE
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48340-1025
Country	:	US
Telephone Number	:	248-745-6731
Fax Number	:

Provider Business Practice Location Address
First Line	:	55185 SHELBY RD
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-1150
Country	:	US
Telephone Number	:	248-650-5200
Fax Number	:	248-651-1948

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. LINDA A BLAKE D.C.” Practice Location

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