Provider Demographics
NPI:1700217965
Name:ROSSO, BLAKE JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:JOSEPH
Last Name:ROSSO
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 1:276 STATE HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-7539
Mailing Address - Country:US
Mailing Address - Phone:207-288-3980
Mailing Address - Fax:
Practice Address - Street 1:276 STATE HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-7539
Practice Address - Country:US
Practice Address - Phone:207-288-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor