Provider Demographics
NPI:1073537759
Name:PRELIPP, BLAKE WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:WILLIAM
Last Name:PRELIPP
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 1:4728 PARK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3490
Mailing Address - Country:US
Mailing Address - Phone:704-527-1020
Mailing Address - Fax:704-527-1060
Practice Address - Street 1:4728 PARK RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3490
Practice Address - Country:US
Practice Address - Phone:704-527-1020
Practice Address - Fax:704-527-1060
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3413111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health