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Individual

DR. EDWARD A. BLANCO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
12464 LA GRANGE RD, LOUISVILLE, KY 40245-1901
(502) 205-2090
(502) 205-2091
Mailing address
12464 LA GRANGE RD, LOUISVILLE, KY 40245-1901
(502) 205-2090
(502) 205-2091

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
290033
KY
111N00000X
Chiropractor
DC0000001562
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3970873
TN
Enumeration date
10/04/2006
Last updated
07/17/2024
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