Provider Demographics
NPI:1891932471
Name:ADAIR, BLAINE MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:MICHAEL
Last Name:ADAIR
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 1:1201 W GORE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3642
Mailing Address - Country:US
Mailing Address - Phone:580-353-6776
Mailing Address - Fax:
Practice Address - Street 1:1201 W GORE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3642
Practice Address - Country:US
Practice Address - Phone:580-353-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK402695Medicare UPIN