Blake Chiropractic & Rehab Clinic Inc

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

PA0002487 Issued in PA

Legal business name

BLAKE CHIROPRACTIC & REHAB CLINIC INC

Practice address

275 S Houcks Rd
Harrisburg, PA 17109-2907

Phone

(717) 657-2561

Fax

(717) 657-8217

NPI assigned

Nov 16, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Robert O Blake, D.C.NPI 1447380456

Title

Doctor

Phone

(717) 657-2561

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 2

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

• Robert O Blake, D.C.

  • Rehabilitation Chiropractor
  • Harrisburg, PA
  • NPI 1447380456
  Medicare reassignment NPD Authorized official
• John James Costopoulos, D.O.

  • Chiropractor
  • Harrisburg, PA
  • NPI 1134292261
  NPD (past)

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339372800000",
    "number": "1871666990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 S HOUCKS RD",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171092907",
            "telephone_number": "717-657-2561",
            "fax_number": "717-657-8217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 S HOUCKS RD",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171092907",
            "telephone_number": "717-657-2561",
            "fax_number": "717-657-8217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKE CHIROPRACTIC & REHAB CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2012-06-11",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "717-657-2561",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "PA",
            "license": "PA0002487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "BL1840042",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "3000116",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITOL BLUE CROSS",
            "identifier": "02520900",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0937995",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Saralynn Black, COTA
• William Edward Black, D.M.D.
• Ashley Blaha
• Sally Ann Blaine, MD
• Angela Blair
• Chiquita Blake
• Robert O Blake, D.C.
• Vonda L Blasick, CRNP
• Rachel L Blatt, BA
• Rebecca Blazi, M.A. CCC-SLP

• Rehabilitation Chiropractor in Harrisburg, PA
• Providers in Harrisburg, PA by specialty
• Rehabilitation Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; 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.