Provider Demographics
NPI:1245396746
Name:BLAIR, MARY F (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:F
Last Name:BLAIR
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 1:207 N MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1755
Mailing Address - Country:US
Mailing Address - Phone:618-281-9202
Mailing Address - Fax:618-281-9203
Practice Address - Street 1:207 N MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1755
Practice Address - Country:US
Practice Address - Phone:618-281-9202
Practice Address - Fax:618-281-9203
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL273911OtherGHP
IL7256584OtherAETNA
IL0006732016OtherBLUE CROSS BLUE SHIELD
IL666612OtherUNITED HEALTH CARE
IL676122OtherHEALTHLINK
ILV01029Medicare UPIN
IL0006732016OtherBLUE CROSS BLUE SHIELD