Provider Demographics
NPI:1245434794
Name:BLASE CHIROPRACTIC
Entity type:Organization
Organization Name:BLASE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLASE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-625-1750
Mailing Address - Street 1:177 NC HIGHWAY 42 N STE A
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-7955
Mailing Address - Country:US
Mailing Address - Phone:336-625-1750
Mailing Address - Fax:336-629-7650
Practice Address - Street 1:177 NC HIGHWAY 42 N STE A
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-7955
Practice Address - Country:US
Practice Address - Phone:336-625-1750
Practice Address - Fax:336-629-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908259Medicaid
NC89085K0Medicaid
NC244215Medicare ID - Type Unspecified
NC89085K0Medicaid
NC8908259Medicaid
NCU93617Medicare UPIN