Provider Demographics
NPI:1659072460
Name:BLAKESLEE, ZACHARY (DC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:BLAKESLEE
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 1:2 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-1312
Mailing Address - Country:US
Mailing Address - Phone:814-347-5169
Mailing Address - Fax:
Practice Address - Street 1:2 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1312
Practice Address - Country:US
Practice Address - Phone:716-499-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor