Thomas Leon Blake, D.C.

Key facts

NPI

1013075746

Entity type

Individual (NPI type 1)

Primary specialty

Chiropractor 111N00000X

License

2074 (NC)

Practice address

104 North Greensboro Street
Liberty, NC 27298-3203

Phone

(336) 622-1600

NPI assigned

Dec 5, 2006

Sex

Male

Sole proprietor

Yes

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.

• Dr Thomas Blake Inc Chiropractor · Liberty, NC · NPI 1912188293
  NPD (past) Authorized official CHIROPRACTOR

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 24, 2007.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187913600000",
    "number": "1013075746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3199 CARRIAGE CREEK CT",
            "city": "HAW RIVER",
            "state": "NC",
            "postal_code": "272589047",
            "telephone_number": "336-261-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 NORTH GREENSBORO STREET",
            "city": "LIBERTY",
            "state": "NC",
            "postal_code": "272983203",
            "telephone_number": "336-622-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "THOMAS",
        "middle_name": "LEON",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "2074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890830H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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