Provider Demographics
NPI:1790081537
Name:BLAKEMORE CALIFORNIA CHIROPRACTIC OFFICE, INC.
Entity Type:Organization
Organization Name:BLAKEMORE CALIFORNIA CHIROPRACTIC OFFICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:BLAKEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-871-2495
Mailing Address - Street 1:159 N RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4609
Mailing Address - Country:US
Mailing Address - Phone:714-871-2495
Mailing Address - Fax:714-871-2495
Practice Address - Street 1:159 N RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4609
Practice Address - Country:US
Practice Address - Phone:714-871-2495
Practice Address - Fax:714-871-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12131111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty