Provider Demographics
NPI:1851360747
Name:BLASSENGALE, HERBERT A (CH)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:A
Last Name:BLASSENGALE
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 PENDLETON STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3307
Mailing Address - Country:US
Mailing Address - Phone:864-232-5488
Mailing Address - Fax:864-232-5388
Practice Address - Street 1:713 PENDLETON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3321
Practice Address - Country:US
Practice Address - Phone:864-232-5488
Practice Address - Fax:864-232-5388
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH354Medicaid
SCGCH354Medicaid