Provider Demographics
NPI:1053704304
Name:BLAKE, BRITTANY ALEXANDRA (DC)
Entity type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:ALEXANDRA
Last Name:BLAKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 S COLONY WAY
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6929
Mailing Address - Country:US
Mailing Address - Phone:907-745-2575
Mailing Address - Fax:907-745-2576
Practice Address - Street 1:1030 S COLONY WAY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6929
Practice Address - Country:US
Practice Address - Phone:907-745-2575
Practice Address - Fax:907-745-2576
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor