Provider Demographics
NPI:1609916808
Name:BLANKENBAKER, THOMAS E (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:BLANKENBAKER
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 1:1727 E BELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2800
Mailing Address - Country:US
Mailing Address - Phone:602-867-7246
Mailing Address - Fax:602-494-7246
Practice Address - Street 1:1727 E BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2800
Practice Address - Country:US
Practice Address - Phone:602-867-7246
Practice Address - Fax:602-494-7246
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3164111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation