Provider Demographics
NPI:1508059403
Name:BLANKENSHIP, DINA MAPLES (DC)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:MAPLES
Last Name:BLANKENSHIP
Suffix:
Gender:F
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:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-0248
Mailing Address - Country:US
Mailing Address - Phone:803-438-1177
Mailing Address - Fax:
Practice Address - Street 1:810 RIDGEWAY ROAD
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-0248
Practice Address - Country:US
Practice Address - Phone:803-438-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor