Provider Demographics
NPI:1033442678
Name:BLACKWOOD, KIRK R (DC)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:R
Last Name:BLACKWOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E MAIN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4430
Mailing Address - Country:US
Mailing Address - Phone:701-751-4485
Mailing Address - Fax:701-751-4486
Practice Address - Street 1:521 E MAIN AVE STE 400
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4430
Practice Address - Country:US
Practice Address - Phone:701-751-4485
Practice Address - Fax:701-751-4486
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor