Provider Demographics
NPI:1568760346
Name:UPSTON, BLAKE CABLE (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:CABLE
Last Name:UPSTON
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 1:4200 W MICHIGAN AVE
Mailing Address - Street 2:SUITE 231
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-5892
Mailing Address - Country:US
Mailing Address - Phone:269-986-0572
Mailing Address - Fax:
Practice Address - Street 1:4200 W MICHIGAN AVE
Practice Address - Street 2:SUITE 231
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-5892
Practice Address - Country:US
Practice Address - Phone:269-986-0572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor