Individual
KENNETH BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
H.I.S.
Contact information
Practice address
39000 BOB HOPE DRIVE PROBST 315, RANCHO MIRAGE, CA 92270-3221
(760) 625-6616
(442) 666-3766
Mailing address
39000 BOB HOPE DRIVE PROBST 315, RANCHO MIRAGE, CA 92270-3221
(760) 625-6616
(442) 666-3766
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
DC17237
CA
111N00000X
Chiropractor
DC172371
CA
237700000X
Hearing Instrument Specialist
Primary
HA7407
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC172371
INSURANCE COMPANIES
CA
Enumeration date
07/15/2006
Last updated
06/04/2019
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