Provider Demographics
NPI:1356326847
Name:BLAIR, ROBERT W (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:BLAIR
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:PO BOX 182
Mailing Address - Street 2:14949 KINSMAN RD.
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021-0182
Mailing Address - Country:US
Mailing Address - Phone:440-834-0009
Mailing Address - Fax:440-834-0017
Practice Address - Street 1:14949 KINSMAN RD
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-8277
Practice Address - Country:US
Practice Address - Phone:440-834-0009
Practice Address - Fax:440-834-0017
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0387228Medicaid
OHBL0447472Medicare ID - Type Unspecified
OH0387228Medicaid