Provider Demographics
NPI:1538319389
Name:BLACKLEY, DAMON CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:CARL
Last Name:BLACKLEY
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 1:2010 SADDLEBRED DR
Mailing Address - Street 2:
Mailing Address - City:IRON STATION
Mailing Address - State:NC
Mailing Address - Zip Code:28080-9374
Mailing Address - Country:US
Mailing Address - Phone:910-827-1170
Mailing Address - Fax:910-735-8280
Practice Address - Street 1:108 NEWBOLD ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3906
Practice Address - Country:US
Practice Address - Phone:704-735-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor