Provider Demographics
NPI:1376870170
Name:BLACKSTONE, MARC (DC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
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 1:9832 N HAYDEN RD
Mailing Address - Street 2:#207
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1298
Mailing Address - Country:US
Mailing Address - Phone:480-244-1830
Mailing Address - Fax:480-556-6670
Practice Address - Street 1:9832 N HAYDEN RD
Practice Address - Street 2:SUITE #207
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1298
Practice Address - Country:US
Practice Address - Phone:480-244-1830
Practice Address - Fax:480-556-6670
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ149672Medicare PIN