Provider Demographics
NPI:1194840173
Name:BLAIN, DEBORAH ANN (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
Last Name:BLAIN
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:THRIFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1621 TOWNE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3654
Mailing Address - Country:US
Mailing Address - Phone:573-474-8800
Mailing Address - Fax:573-474-8088
Practice Address - Street 1:1621 TOWNE DR
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3654
Practice Address - Country:US
Practice Address - Phone:573-474-8800
Practice Address - Fax:573-474-8088
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4409000OtherUNITED HEALTH CARE
MO000000471379OtherBLUE CROSS AND BLUE SHIE
MO005013460Medicare ID - Type UnspecifiedMEDICARE NUMBER
MO4409000OtherUNITED HEALTH CARE