Provider Demographics
NPI:1811345226
Name:DR. CHERYL BLANKENSHIP LLC
Entity type:Organization
Organization Name:DR. CHERYL BLANKENSHIP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:CHAO
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:860-886-2882
Mailing Address - Street 1:148 SACHEM ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-4131
Mailing Address - Country:US
Mailing Address - Phone:860-886-2882
Mailing Address - Fax:860-886-6886
Practice Address - Street 1:148 SACHEM ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-4131
Practice Address - Country:US
Practice Address - Phone:860-886-2882
Practice Address - Fax:860-886-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000494171100000X
CT001644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
350001424Medicare PIN
CTV06575Medicare UPIN