Provider Demographics
NPI:1467650226
Name:BLAKER, CHARLES ALLEN (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALLEN
Last Name:BLAKER
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:DR
Other - First Name:CHAD
Other - Middle Name:ALLEN
Other - Last Name:BLAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:7801 YORK ROAD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7442
Mailing Address - Country:US
Mailing Address - Phone:410-823-2626
Mailing Address - Fax:410-823-7611
Practice Address - Street 1:7801 YORK ROAD
Practice Address - Street 2:SUITE 124
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7442
Practice Address - Country:US
Practice Address - Phone:410-823-2626
Practice Address - Fax:410-823-7611
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD470L196VMedicare ID - Type Unspecified