Provider Demographics
NPI:1275722670
Name:BLACKBURN, JAYE CAROLYN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAYE
Middle Name:CAROLYN
Last Name:BLACKBURN
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 1:500 TYRONE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7125
Mailing Address - Country:US
Mailing Address - Phone:727-345-7427
Mailing Address - Fax:727-347-1172
Practice Address - Street 1:500 TYRONE BOULEVARD
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7125
Practice Address - Country:US
Practice Address - Phone:727-345-7427
Practice Address - Fax:727-347-1172
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor