Provider Demographics
NPI:1316587082
Name:KLESSIG, BLAKE ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:ALLEN
Last Name:KLESSIG
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 1:6580 OLD MONROE RD STE A
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5362
Mailing Address - Country:US
Mailing Address - Phone:704-225-8686
Mailing Address - Fax:
Practice Address - Street 1:6580 OLD MONROE RD STE A
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5362
Practice Address - Country:US
Practice Address - Phone:704-225-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor