Provider Demographics
NPI:1265550172
Name:BLANTON-MCCALVIN, AMBER BETH (DC)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:BETH
Last Name:BLANTON-MCCALVIN
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:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:SOUTH SHORE
Mailing Address - State:KY
Mailing Address - Zip Code:41175-0022
Mailing Address - Country:US
Mailing Address - Phone:606-932-2414
Mailing Address - Fax:606-932-2421
Practice Address - Street 1:283500 US HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175-0022
Practice Address - Country:US
Practice Address - Phone:606-932-2414
Practice Address - Fax:606-932-2421
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor