Provider Demographics
NPI:1114907854
Name:MASTERS, BLAIR B (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:B
Last Name:MASTERS
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 1:1583 MAIN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5214
Mailing Address - Country:US
Mailing Address - Phone:479-443-0800
Mailing Address - Fax:479-443-5538
Practice Address - Street 1:1583 MAIN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5214
Practice Address - Country:US
Practice Address - Phone:479-443-0800
Practice Address - Fax:479-443-5538
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20651Medicare UPIN
AR59396Medicare ID - Type UnspecifiedMEDICARE NUMBER