Provider Demographics
NPI:1255432084
Name:BLAHNIK-MOTON, CHERYL LEA (DC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LEA
Last Name:BLAHNIK-MOTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2123
Mailing Address - Country:US
Mailing Address - Phone:309-797-4788
Mailing Address - Fax:
Practice Address - Street 1:719 16TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2123
Practice Address - Country:US
Practice Address - Phone:309-797-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38420OtherBCBS