Provider Demographics
NPI:1245388792
Name:BLANKSMA, PETE L (DC)
Entity Type:Individual
Prefix:DR
First Name:PETE
Middle Name:L
Last Name:BLANKSMA
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 1:320 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2107
Mailing Address - Country:US
Mailing Address - Phone:509-663-5244
Mailing Address - Fax:509-664-6508
Practice Address - Street 1:320 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2107
Practice Address - Country:US
Practice Address - Phone:509-663-5244
Practice Address - Fax:509-664-6508
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0005045375OtherAETNA
WA0199687OtherDEPT. OF L & I
WA2014058OtherDSHS
WA446833OtherSTERLING LIFE INS
WA2014058Medicaid
WA911678119 BL1169OtherASURIS NORTHWEST
WA145724145724OtherLIFEWISE
WA9978301OtherCIGNA
WA145724145724OtherPREMERA BLUE CROSS