Provider Demographics
NPI:1770611204
Name:EUBANKS, BLAKE RUSSELL (D,C)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:RUSSELL
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:D,C
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 58312
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8312
Mailing Address - Country:US
Mailing Address - Phone:713-392-8527
Mailing Address - Fax:
Practice Address - Street 1:1730 NASA PKWY
Practice Address - Street 2:STE # 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3539
Practice Address - Country:US
Practice Address - Phone:713-392-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9228111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition