Provider Demographics
NPI:1710063458
Name:BLACKWELL, JON DARIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:DARIN
Last Name:BLACKWELL
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 1:5701 I-40 WEST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4619
Mailing Address - Country:US
Mailing Address - Phone:806-358-3595
Mailing Address - Fax:806-358-4647
Practice Address - Street 1:5701 W INTERSTATE 40
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4619
Practice Address - Country:US
Practice Address - Phone:806-358-3595
Practice Address - Fax:806-358-4647
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0067237OtherBLUE LINK
TX8J2131OtherBLUE CROSS BLUE SHIELD
TXU82696Medicare UPIN
TX0067237OtherBLUE LINK