Provider Demographics
NPI:1639419963
Name:KALKSTEIN, BLAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:KALKSTEIN
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 1:200 E JOPPA RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3150
Mailing Address - Country:US
Mailing Address - Phone:410-296-7700
Mailing Address - Fax:410-296-7784
Practice Address - Street 1:200 E JOPPA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3150
Practice Address - Country:US
Practice Address - Phone:410-296-7700
Practice Address - Fax:410-296-7784
Is Sole Proprietor?:No
Enumeration Date:2013-02-23
Last Update Date:2014-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03735111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation