Provider Demographics
NPI:1942446067
Name:BLACKBURN CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BLACKBURN CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:HOLLIS
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-420-9300
Mailing Address - Street 1:4107 MEDICAL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3736
Mailing Address - Country:US
Mailing Address - Phone:512-810-0667
Mailing Address - Fax:512-420-9390
Practice Address - Street 1:4107 MEDICAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3736
Practice Address - Country:US
Practice Address - Phone:512-810-0667
Practice Address - Fax:512-420-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty