Provider Demographics
NPI:1063844462
Name:BLAIR, JUSTIN GENE (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:GENE
Last Name:BLAIR
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 1:2026 54TH AVE E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-1904
Mailing Address - Country:US
Mailing Address - Phone:253-922-0450
Mailing Address - Fax:253-926-1720
Practice Address - Street 1:2026 54TH AVE E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-1904
Practice Address - Country:US
Practice Address - Phone:253-922-0450
Practice Address - Fax:253-926-1720
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60402219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor