Provider Demographics
NPI:1669464947
Name:BLACKMON, CHRISTOPHER ROYSE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ROYSE
Last Name:BLACKMON
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 1:7000 CANTRELL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-4139
Mailing Address - Country:US
Mailing Address - Phone:501-663-4101
Mailing Address - Fax:501-663-7526
Practice Address - Street 1:7000 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-4139
Practice Address - Country:US
Practice Address - Phone:501-663-4101
Practice Address - Fax:501-663-7526
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU57671Medicare UPIN
AR5T104Medicare ID - Type UnspecifiedCHIROPRACTOR