Provider Demographics
NPI:1134331275
Name:BLANKENBEHLER, WILLIAM ANDREW JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:BLANKENBEHLER
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:ANDREW
Other - Last Name:BLANKENBEHLER
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:901 SUNRISE AVE STE B11
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4560
Mailing Address - Country:US
Mailing Address - Phone:916-521-4000
Mailing Address - Fax:
Practice Address - Street 1:901 SUNRISE AVE STE B11
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4560
Practice Address - Country:US
Practice Address - Phone:916-521-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26346111N00000X
CA813250163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No111N00000XChiropractic ProvidersChiropractor