Blackburn Clinic, Inc. PS

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

CH00034702 Issued in WA

Legal business name

BLACKBURN CLINIC, INC. PS

Doing business as

Rebound

Practice address

11107 SE Kent Kangley Rd
Kent, WA 98030-7707

Phone

(253) 854-8880

Fax

(253) 854-7160

NPI assigned

Jan 8, 2008

Last updated

Jan 8, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gary Patrick Blackburn, D.C, CCSP

Title

Owner

Phone

(253) 854-8880

Specialties & licenses 1

Addresses

Other names 1

• Rebound Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brandon Edward Perkes, DC

  • Chiropractor
  • Bonney Lake, WA
  • NPI 1740507805
  NPD (past)
• Shannon Rachael Schueren, DC

  • Chiropractor
  • Mill Creek, WA
  • NPI 1477190304
  NPD (past)
• Alexander W Sobel, D.O.

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Bellevue, WA
  • NPI 1992913917
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199750400000",
    "number": "1083899066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11107 SE KENT KANGLEY RD",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307707",
            "telephone_number": "253-854-8880",
            "fax_number": "253-854-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11107 SE KENT KANGLEY RD",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307707",
            "telephone_number": "253-854-8880",
            "fax_number": "253-854-7160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKBURN CLINIC, INC. PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-08",
        "last_updated": "2008-01-08",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-854-8880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C, CCSP"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "WA",
            "license": "CH00034702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rebound",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cherinet Tinsae Birhanu Sr., CNA
• Tambra Kay Birkebak
• BJ Kim
• Eva Blacconiere, DPT
• Nicole Marie Black
• William Kelly Blackburn, MASSAGE THERAPY
• Sheryl Alice Blake, MSW
• Aisa Marie Blanchard, BS
• Matthew S Blessing, MD
• Joshua Bleustar, LMHC, NCC, ADS

• Sports Physician Chiropractor in Kent, WA
• Providers in Kent, WA by specialty
• Sports Physician Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.