Provider Demographics
NPI:1326272659
Name:BLACKSTONE, THOMAS D (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:BLACKSTONE
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 1:1605 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-2409
Mailing Address - Country:US
Mailing Address - Phone:308-436-2801
Mailing Address - Fax:308-436-2872
Practice Address - Street 1:1605 10TH ST
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-2409
Practice Address - Country:US
Practice Address - Phone:308-436-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor