Provider Demographics
NPI:1932275203
Name:BLANCHARD, JERRY DEAN (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:DEAN
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:CHIROPRACTOR
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 185
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-0185
Mailing Address - Country:US
Mailing Address - Phone:701-352-1690
Mailing Address - Fax:701-352-2258
Practice Address - Street 1:631 W 12TH STREET
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-0185
Practice Address - Country:US
Practice Address - Phone:701-352-1690
Practice Address - Fax:701-352-2258
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND311111N00000X
ND1610111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10544Medicaid
MN8Z546BLOtherBLUE SHIELD MINNESOTA
ND4232OtherBLUE SHIELD NORTH DAKOTA
NDN4232Medicare PIN
MN8Z546BLOtherBLUE SHIELD MINNESOTA