Active NPI
Blake W Squire, D.C.
- Chiropractor
- Saint Petersburg, FL
National Provider Identifier
1073970992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH 11779
- Practice address
- 5105 Central Ave
Saint Petersburg, FL 33710-8140 - Phone
- (727) 698-6088
- NPI assigned
- Jan 22, 2016
- 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 | CH 11779 | FL | Primary |
Addresses
Primary practice location
5105 Central Ave
Saint Petersburg, FL 33710-8140
Mailing address
PO Box 735
Parrish, FL 34219-0735
Phone (407) 369-0394
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 |
|---|---|---|---|
| CH 11779 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453420800000",
"number": "1073970992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 735",
"city": "PARRISH",
"state": "FL",
"postal_code": "342190735",
"telephone_number": "407-369-0394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5105 CENTRAL AVE",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337108140",
"telephone_number": "727-698-6088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SQUIRE",
"first_name": "BLAKE",
"middle_name": "W",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-01-22",
"last_updated": "2016-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH 11779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.