Glenn D Blankenhorn III, DO

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

34003712 Issued in OH

Practice address

3300 Bailey St NW
Ste 104
Massillon, OH 44646-3613

Phone

(330) 837-3823

Fax

(330) 837-8313

NPI assigned

Jun 9, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197849600000",
    "number": "1497759369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 BAILEY ST NW",
            "address_2": "STE 104",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446463613",
            "telephone_number": "330-837-3823",
            "fax_number": "330-837-8313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 BAILEY ST NW",
            "address_2": "STE 104",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446463613",
            "telephone_number": "330-837-3823",
            "fax_number": "330-837-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANKENHORN",
        "first_name": "GLENN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2007-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "OH",
            "license": "34003712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0586852",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Neuromusculoskeletal Medicine & OMM Physician in Massillon, OH
• Providers in Massillon, OH by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; 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.