Provider Demographics
NPI:1245263128
Name:SPOONER, BLAKE RUSHFORD (DC)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:RUSHFORD
Last Name:SPOONER
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 1:258 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1806
Mailing Address - Country:US
Mailing Address - Phone:616-396-6635
Mailing Address - Fax:616-499-4717
Practice Address - Street 1:244 JAMES ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2980
Practice Address - Country:US
Practice Address - Phone:616-403-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor