Provider Demographics
NPI:1508206731
Name:BLATT, DAVID (LAC, CPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BLATT
Suffix:
Gender:M
Credentials:LAC, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 E 17TH AVENUE PKWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1126
Mailing Address - Country:US
Mailing Address - Phone:415-690-6699
Mailing Address - Fax:
Practice Address - Street 1:3500 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1813
Practice Address - Country:US
Practice Address - Phone:720-577-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15456171100000X
CO2138171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist