Provider Demographics
NPI:1780738492
Name:HAAN, BLAKE LOWELL (DC)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:LOWELL
Last Name:HAAN
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 1:304 SE DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-9346
Mailing Address - Country:US
Mailing Address - Phone:515-965-1643
Mailing Address - Fax:515-963-4394
Practice Address - Street 1:304 SE DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-9346
Practice Address - Country:US
Practice Address - Phone:515-965-1643
Practice Address - Fax:515-963-4394
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA51847OtherBLUE CROSS BLUE SHIELD
IAU57321Medicare UPIN
IAI15242Medicare PIN