Provider Demographics
NPI:1083874507
Name:BLASK, BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:BLASK
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 1:5112 W. TAFT RD.
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-452-9420
Mailing Address - Fax:315-452-9132
Practice Address - Street 1:5112 W. TAFT RD.
Practice Address - Street 2:SUITE 1B
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-452-9420
Practice Address - Fax:315-452-9132
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor