Provider Demographics
NPI:1649325804
Name:PAUL BLANK,D.C.,LLC
Entity type:Organization
Organization Name:PAUL BLANK,D.C.,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-925-1371
Mailing Address - Street 1:500 N WOOD AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4160
Mailing Address - Country:US
Mailing Address - Phone:908-925-1371
Mailing Address - Fax:908-925-0332
Practice Address - Street 1:500 N WOOD AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4160
Practice Address - Country:US
Practice Address - Phone:908-925-1371
Practice Address - Fax:908-925-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ452676B9EMedicare PIN