Provider Demographics
NPI:1851585731
Name:DOSS, BLAKE ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:ANDREW
Last Name:DOSS
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 1:389 W WEAVER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535-9800
Mailing Address - Country:US
Mailing Address - Phone:217-875-7151
Mailing Address - Fax:
Practice Address - Street 1:389 W WEAVER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-9800
Practice Address - Country:US
Practice Address - Phone:217-875-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38011008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor