Provider Demographics
NPI:1205598836
Name:PARKINSON, BLASE WALTER (DC)
Entity type:Individual
Prefix:DR
First Name:BLASE
Middle Name:WALTER
Last Name:PARKINSON
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 1:108 MIDWAY CT
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6727
Mailing Address - Country:US
Mailing Address - Phone:772-205-9413
Mailing Address - Fax:
Practice Address - Street 1:9414 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-6398
Practice Address - Country:US
Practice Address - Phone:772-228-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor