Provider Demographics
NPI:1720463268
Name:BLAIR, RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BLAIR
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:HANALEI
Mailing Address - State:HI
Mailing Address - Zip Code:96714-0421
Mailing Address - Country:US
Mailing Address - Phone:808-826-6622
Mailing Address - Fax:
Practice Address - Street 1:5-5080 KUHIO HIGHWAY
Practice Address - Street 2:A
Practice Address - City:HANALEI
Practice Address - State:HI
Practice Address - Zip Code:96714-0421
Practice Address - Country:US
Practice Address - Phone:808-826-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor