Provider Demographics
NPI:1851844823
Name:PEARSON, BLAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:PEARSON
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 1:603 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1942
Mailing Address - Country:US
Mailing Address - Phone:641-236-9852
Mailing Address - Fax:641-236-1708
Practice Address - Street 1:603 6TH AVE
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1942
Practice Address - Country:US
Practice Address - Phone:641-236-9852
Practice Address - Fax:641-236-1708
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor