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Organization
ERBLAZ
Active
Organization
ERBLAZ
Active
Other names
Upstate Ketamine and Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BLASENAK DO (MEMBER)
(864) 533-0029
Entity
Organization
Contact information
Practice address
130 DILLON DR, SPARTANBURG, SC 29307-1018
(864) 365-3000
Mailing address
2391 ROPER MOUNTAIN RD, SIMPSONVILLE, SC 29681-4937
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
07/12/2023
Last updated
07/12/2023
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