Clyde Spencer Blackwelder, D.C.
Individual provider Active NPI Chiropractor · Dana Point, CA
NPI 1992880199 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992880199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- DC23746 (CA)
- Practice address
- 24721 La PLZ
Dana Point, CA 92629-2509 - Phone
- (949) 240-2546
- Fax
- (949) 240-3804
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC23746 | CA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blackwelder Chiropractic, Inc. | Chiropractor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC23746 | CA | Yes |
Addresses
Primary practice location
24721 La PLZ
Dana Point, CA 92629-2509
Mailing address
25762 Via del Rey
San Juan Capistrano, CA 92675-4444
Phone (949) 240-0483
Other providers in Dana Point, CA
- Bewell Orange County LLC
- Alisa Marie Beyer
- Maya B Bidichandani-Kaura
- Wade Mattson Binley
- Blackwelder Chiropractic, Inc.
- Lorilee Bohn
- Carey Jamison Bornhagen
- Judy Lynn Bourget
- Bouwhuis Chiropractic Corp
- Dustin J Bouwhuis
All providers in Dana Point, CA · Chiropractor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.