Provider Demographics
NPI:1851471205
Name:BLACKMAN, MICHAEL DOUGLAS (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:BLACKMAN
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 CLEVELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1115
Mailing Address - Country:US
Mailing Address - Phone:716-832-2593
Mailing Address - Fax:716-835-3134
Practice Address - Street 1:841 CLEVELAND DRIVE
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1115
Practice Address - Country:US
Practice Address - Phone:716-832-2593
Practice Address - Fax:716-835-3134
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0029311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17757BMedicare ID - Type Unspecified