Provider Demographics
NPI:1457836348
Name:PRALL, BLAKE (DC)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:PRALL
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 1:2780 HOMESTEAD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5464
Mailing Address - Country:US
Mailing Address - Phone:775-727-7959
Mailing Address - Fax:775-727-7960
Practice Address - Street 1:2780 HOMESTEAD RD STE 105
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5464
Practice Address - Country:US
Practice Address - Phone:775-727-7959
Practice Address - Fax:775-727-7960
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB01702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor