Provider Demographics
NPI:1861642894
Name:BLAKENEY FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:BLAKENEY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:BERHE
Authorized Official - Last Name:SEREKEBERHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-841-2504
Mailing Address - Street 1:10607 REA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6524
Mailing Address - Country:US
Mailing Address - Phone:704-841-2504
Mailing Address - Fax:704-841-2508
Practice Address - Street 1:10607 REA RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6524
Practice Address - Country:US
Practice Address - Phone:704-841-2504
Practice Address - Fax:704-841-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3326261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center