Individual
DR. BLAKE ROBERT PENNOCK II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1501 S YALE ST STE 250, FLAGSTAFF, AZ 86001-7336
(928) 557-0707
Mailing address
505 W BASELINE RD APT 2142, TEMPE, AZ 85283-5319
(563) 249-7446
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
8787
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/13/2019
Last updated
02/22/2019
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