Provider Demographics
NPI:1932113602
Name:BLAXBERG, NEAL BARRON (DC)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:BARRON
Last Name:BLAXBERG
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 1:7 CHURCH LN
Mailing Address - Street 2:SUITE 12
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3710
Mailing Address - Country:US
Mailing Address - Phone:410-484-0666
Mailing Address - Fax:410-486-0816
Practice Address - Street 1:7 CHURCH LN
Practice Address - Street 2:SUITE 12
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3710
Practice Address - Country:US
Practice Address - Phone:410-484-0666
Practice Address - Fax:410-486-0816
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01269PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCR078OtherBLUE CROSS
MDM100OtherBCBS OF MD
DCR078OtherBLUE CROSS
MDT59533Medicare UPIN