Provider Demographics
NPI:1699847806
Name:BLANCO, LUKE ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:ANTHONY
Last Name:BLANCO
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 JULIA TER
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-6614
Mailing Address - Country:US
Mailing Address - Phone:203-240-2235
Mailing Address - Fax:
Practice Address - Street 1:460 HARTFORD TPKE
Practice Address - Street 2:SUITE B
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4845
Practice Address - Country:US
Practice Address - Phone:860-872-6229
Practice Address - Fax:860-760-6400
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001560Medicare PIN