Provider Demographics
NPI:1083011175
Name:NEAL B. BLAXBERG, D.C., LLC
Entity Type:Organization
Organization Name:NEAL B. BLAXBERG, D.C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLAXBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-484-0666
Mailing Address - Street 1:7 CHURCH LN
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3710
Mailing Address - Country:US
Mailing Address - Phone:410-484-0666
Mailing Address - Fax:410-486-0816
Practice Address - Street 1:7 CHURCH LN
Practice Address - Street 2:SUITE 12
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3710
Practice Address - Country:US
Practice Address - Phone:410-484-0666
Practice Address - Fax:410-486-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty