Provider Demographics
NPI:1972666774
Name:BLAKE, RICHARD DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DANIEL
Last Name:BLAKE
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:BOX 20
Mailing Address - Street 2:8 GLEN ROAD POWERHOUSE MALL
Mailing Address - City:W LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784
Mailing Address - Country:US
Mailing Address - Phone:603-298-6500
Mailing Address - Fax:603-298-6525
Practice Address - Street 1:8 GLEN ROAD
Practice Address - Street 2:POWERHOUSE MALL
Practice Address - City:W LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784
Practice Address - Country:US
Practice Address - Phone:603-298-6500
Practice Address - Fax:603-298-6525
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH156A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH8656Medicare ID - Type Unspecified