Provider Demographics
NPI:1114035011
Name:BLAKE, ANTHONY RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:RAY
Last Name:BLAKE
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 1:313 S JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3905
Mailing Address - Country:US
Mailing Address - Phone:605-224-2611
Mailing Address - Fax:
Practice Address - Street 1:1205 N HARRISON AVE
Practice Address - Street 2:STE 203
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-2395
Practice Address - Country:US
Practice Address - Phone:605-945-2225
Practice Address - Fax:605-945-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor