Provider Demographics
NPI:1598722928
Name:AWERKAMP, BLAINE A (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:A
Last Name:AWERKAMP
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 1:8394 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0505
Mailing Address - Country:US
Mailing Address - Phone:801-562-0135
Mailing Address - Fax:801-562-0174
Practice Address - Street 1:8394 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0505
Practice Address - Country:US
Practice Address - Phone:801-562-0135
Practice Address - Fax:801-562-0174
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT175587-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT350056587OtherRAILROAD MEDICARE
UT000005871Medicare ID - Type Unspecified
UT350056587OtherRAILROAD MEDICARE