Provider Demographics
NPI:1164122420
Name:BLACKMAN, ALEYA RENEA (DC)
Entity Type:Individual
Prefix:
First Name:ALEYA
Middle Name:RENEA
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W AIRPORT FWY STE 810
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6285
Mailing Address - Country:US
Mailing Address - Phone:972-392-3400
Mailing Address - Fax:972-392-3499
Practice Address - Street 1:800 W AIRPORT FWY STE 810
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6285
Practice Address - Country:US
Practice Address - Phone:972-392-3400
Practice Address - Fax:972-392-3499
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor