Provider Demographics
NPI:1760431316
Name:BLALOCK, WILLIAM E (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:BLALOCK
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 1:118 GILES DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-6033
Mailing Address - Country:US
Mailing Address - Phone:864-578-5435
Mailing Address - Fax:864-814-6230
Practice Address - Street 1:118 GILES DR
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-6033
Practice Address - Country:US
Practice Address - Phone:864-578-5435
Practice Address - Fax:864-814-6230
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH306Medicaid
SCGCH306Medicaid
SCU798710281Medicare UPIN