North East Chiropractic PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

02079 Issued in MD

Legal business name

NORTH EAST CHIROPRACTIC PA

Practice address

2316 Pulaski Hwy Ste B
North East, MD 21901-3730

Phone

(410) 642-9110

Fax

(410) 642-9113

NPI assigned

Apr 16, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Heather McCoy Blackiston, D.C.NPI 1619926623

Title

Owner

Phone

(410) 642-9110

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Blackiston Chiropractic Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather McCoy Blackiston, DC

  • Chiropractor
  • North East, MD
  • NPI 1619926623
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1740405604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2316 PULASKI HWY STE B",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219013730",
            "telephone_number": "410-642-9110",
            "fax_number": "410-642-9113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2316 PULASKI HWY STE B",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219013730",
            "telephone_number": "410-642-9110",
            "fax_number": "410-642-9113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2057 Pulaski Hwy Ste 4",
            "address_purpose": "LOCATION",
            "city": "North East",
            "state": "MD",
            "postal_code": "219013744",
            "country_code": "US",
            "telephone_number": "410-642-9110",
            "fax_number": "410-642-9113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTH EAST CHIROPRACTIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "BLACKISTON",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "MCCOY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-642-9110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "02079",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "02079",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC RENDERING PROV. ID",
            "identifier": "61670301",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROV. ID",
            "identifier": "2912304",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackiston Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blackiston Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in North East, MD
• Providers in North East, MD by specialty
• Chiropractor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.