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NPI Code Detail

MEDICARE: CHRISTOPHER BLANCO

MEDICARE: CHRISTOPHER BLANCO
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1548856180
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER BLANCO
Provider Business Mailing Address
First Line : 645 ESSEN LN
Second Line :
City : CHASKA
State : MN
Zip : 55318-2505
Country : US
Telephone Number : 786-768-9072
Fax Number :
Provider Business Practice Location Address
First Line : 2805 CAMPUS DR STE 465
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-2680
Country : US
Telephone Number : 952-946-9777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2020
Last Update Date : 04/20/2026

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Directions to “ CHRISTOPHER BLANCO ” Practice Location

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