Provider Demographics
NPI:1790887354
Name:BLASE, BENJAMIN JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOHN
Last Name:BLASE
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 1:177 NC HIGHWAY 42 N STE A
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-7955
Mailing Address - Country:US
Mailing Address - Phone:336-625-1750
Mailing Address - Fax:336-629-7650
Practice Address - Street 1:177 NC HIGHWAY 42 N STE A
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-7955
Practice Address - Country:US
Practice Address - Phone:336-625-1750
Practice Address - Fax:336-629-7650
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085K0Medicaid
NC89085K0Medicaid
NC2455851Medicare ID - Type Unspecified