Provider Demographics
NPI:1922117597
Name:BLAIS, PAUL NELSON (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:NELSON
Last Name:BLAIS
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 1:2267 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4518
Mailing Address - Country:US
Mailing Address - Phone:706-632-6226
Mailing Address - Fax:706-632-2600
Practice Address - Street 1:2267 E 1ST ST
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4518
Practice Address - Country:US
Practice Address - Phone:706-632-6226
Practice Address - Fax:706-632-2600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U44855Medicare UPIN
GA35ZCCLZMedicare ID - Type Unspecified