Provider Demographics
NPI:1417462060
Name:CAROPINO, BLAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:CAROPINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:BLAKE
Other - Middle Name:
Other - Last Name:CAROPINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2649 E CHARLINDA ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2901
Mailing Address - Country:US
Mailing Address - Phone:626-675-2406
Mailing Address - Fax:
Practice Address - Street 1:26820 CHERRY HILLS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-2531
Practice Address - Country:US
Practice Address - Phone:951-679-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor