Provider Demographics
NPI:1659851574
Name:BLAIR, ALISSA CATHERINE (DC)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:CATHERINE
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 1:308 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:TREYNOR
Mailing Address - State:IA
Mailing Address - Zip Code:51575-7119
Mailing Address - Country:US
Mailing Address - Phone:712-210-1743
Mailing Address - Fax:
Practice Address - Street 1:308 MAPLE DR
Practice Address - Street 2:
Practice Address - City:TREYNOR
Practice Address - State:IA
Practice Address - Zip Code:51575
Practice Address - Country:US
Practice Address - Phone:712-210-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty