Individual
MR. BLAINE M MACDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
804 12TH ST E, GLENCOE, MN 55336-2203
(320) 864-7636
Mailing address
804 12TH ST E, GLENCOE, MN 55336-2203
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3343
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
184R7MA
BCBS PIN NUMBER
MN
01
—
189K2PE
GROUP BCBS PROVIDER NUMBE
MN
Enumeration date
04/19/2007
Last updated
07/08/2007
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