Provider Demographics
NPI:1629528799
Name:BLANKENSHIP, MARTIN KIRBY (DC PA)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:KIRBY
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:DC PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3862 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1202
Mailing Address - Country:US
Mailing Address - Phone:727-310-9401
Mailing Address - Fax:727-310-2996
Practice Address - Street 1:3862 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1202
Practice Address - Country:US
Practice Address - Phone:727-388-0966
Practice Address - Fax:727-310-2996
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor