Provider Demographics
NPI:1447380456
Name:BLAKE, ROBERT O (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:O
Last Name:BLAKE
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 1:275 S HOUCKS RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-2907
Mailing Address - Country:US
Mailing Address - Phone:717-657-2561
Mailing Address - Fax:717-657-8217
Practice Address - Street 1:275 S HOUCKS RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-2907
Practice Address - Country:US
Practice Address - Phone:717-657-2561
Practice Address - Fax:717-657-8217
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA0002487111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation