Individual
REBECCA BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
15480 CLAYTON RD STE 301, BALLWIN, MO 63011-3172
(636) 893-5048
Mailing address
4 DUDDIN CT, MANCHESTER, MO 63021-7025
(314) 668-8816
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2021038711
MO
Other
Enumeration date
07/19/2022
Last updated
07/19/2022
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