Active NPI
Bruce Blakely, D.C.
- Chiropractor
- San Diego, CA
National Provider Identifier
1003999095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 13741
- Practice address
- 2878 Camino del Rio S Ste 120
San Diego, CA 92108-3844 - Phone
- (619) 281-1999
- Fax
- (619) 281-5357
- NPI assigned
- Oct 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 13741 | CA | Primary |
Addresses
Primary practice location
2878 Camino del Rio S Ste 120
San Diego, CA 92108-3844
Mailing address
3570 Camino del Rio N
Ste. 104
San Diego, CA 92108-1747
Phone (619) 281-1999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13741 | CA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bruce E. Blakely, D.C., a Medical Corporation | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- San Diego, CA
- NPI 1851021612
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549497600000",
"number": "1003999095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3570 CAMINO DEL RIO N",
"address_2": "STE. 104",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921081747",
"telephone_number": "619-281-1999",
"fax_number": "619-281-5357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2878 CAMINO DEL RIO S STE 120",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921083844",
"telephone_number": "619-281-1999",
"fax_number": "619-281-5357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKELY",
"first_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-23",
"last_updated": "2019-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "13741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.