Provider Demographics
NPI:1629139688
Name:BLAIR, ELIZABETH LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1932
Mailing Address - Country:US
Mailing Address - Phone:816-561-7035
Mailing Address - Fax:816-960-3890
Practice Address - Street 1:3611 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1932
Practice Address - Country:US
Practice Address - Phone:816-561-7035
Practice Address - Fax:816-960-3890
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005000397111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7854791OtherAETNA PPO
MO36591032OtherBLUE CROSS BLUE SHIELD
MO1196322OtherAETNA HMO
MO694678OtherACN
MO277729OtherCOVENTRY
MO7854791OtherAETNA PPO
MOV08957Medicare UPIN