Provider Demographics
NPI:1013212331
Name:BLAISDELL, CHRISTOPHER SC (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SC
Last Name:BLAISDELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 W 49TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3197
Mailing Address - Country:US
Mailing Address - Phone:305-558-2500
Mailing Address - Fax:
Practice Address - Street 1:1435 W 49TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3197
Practice Address - Country:US
Practice Address - Phone:305-558-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO9508204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM