Provider Demographics
NPI:1134515125
Name:BLAKE TISHMAN, P.A.
Entity Type:Organization
Organization Name:BLAKE TISHMAN, P.A.
Other - Org Name:TISHMAN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-576-7740
Mailing Address - Street 1:9155 RAMBLEWOOD DR APT 317
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7036
Mailing Address - Country:US
Mailing Address - Phone:561-576-7740
Mailing Address - Fax:561-576-7783
Practice Address - Street 1:750 E SAMPLE RD STE 3-4
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5138
Practice Address - Country:US
Practice Address - Phone:561-576-7740
Practice Address - Fax:561-576-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZCH10137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEY351ZMedicare PIN