Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC0000001562 | TN |
NPI | 1013003771 |
---|---|
Provider Name | Dr. Edward A. Blanco |
First Address | Knoxville, TN 37922 |
Second Address | Knoxville, TN 37922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3970873 | (05) | TN |
U77500 | (02) | TN |