Provider Demographics
NPI:1801319249
Name:PATE, BLAKE LEMLEY (DC)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:LEMLEY
Last Name:PATE
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 1:11427 E 110TH PL N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-6688
Mailing Address - Country:US
Mailing Address - Phone:251-227-2186
Mailing Address - Fax:
Practice Address - Street 1:2427 THOMAS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-5808
Practice Address - Country:US
Practice Address - Phone:850-234-2387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor