Provider Demographics
NPI:1750338513
Name:HANRAHAN, BLAKE ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:ROBERT
Last Name:HANRAHAN
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 1:42700 VAN DYKE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3330
Mailing Address - Country:US
Mailing Address - Phone:586-739-8383
Mailing Address - Fax:586-739-6178
Practice Address - Street 1:42700 VAN DYKE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3330
Practice Address - Country:US
Practice Address - Phone:586-739-8383
Practice Address - Fax:586-739-6178
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBH004615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E05146Other0E05146
MI950E017730OtherBCN
MI950E017730OtherBCBS
MI950E017730OtherBCBS
0E05146Other0E05146