Provider Demographics
NPI:1669657433
Name:BLAKER & BLAKER CHIROPRACTIC PA
Entity Type:Organization
Organization Name:BLAKER & BLAKER CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:KEEN
Authorized Official - Last Name:BLAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-823-2626
Mailing Address - Street 1:7801 YORK ROAD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7442
Mailing Address - Country:US
Mailing Address - Phone:410-823-2626
Mailing Address - Fax:410-823-7611
Practice Address - Street 1:7801 YORK ROAD
Practice Address - Street 2:SUITE 124
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-823-2626
Practice Address - Fax:410-823-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD470LMedicare PIN