Provider Demographics
NPI:1841445996
Name:BLANCK, CHERYL ANN (DC, MSC)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:BLANCK
Suffix:
Gender:F
Credentials:DC, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 E THREE NOTCH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36421-2403
Mailing Address - Country:US
Mailing Address - Phone:334-222-2301
Mailing Address - Fax:334-222-2305
Practice Address - Street 1:1805 E THREE NOTCH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36421-2403
Practice Address - Country:US
Practice Address - Phone:334-222-2301
Practice Address - Fax:334-222-2305
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor