MEDICARE: DR. BENJAMIN JOHN BLASE DC

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	3147	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	:	1790887354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN JOHN BLASE DC

Provider Business Mailing Address
First Line	:	177 NC HIGHWAY 42 N STE A
Second Line	:
City	:	ASHEBORO
State	:	NC
Zip	:	27203-7955
Country	:	US
Telephone Number	:	336-625-1750
Fax Number	:	336-629-7650

Provider Business Practice Location Address
First Line	:	177 NC HIGHWAY 42 N STE A
Second Line	:
City	:	ASHEBORO
State	:	NC
Zip	:	27203-7955
Country	:	US
Telephone Number	:	336-625-1750
Fax Number	:	336-629-7650

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

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	07/08/2007

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