Individual
BLAKE BARRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
15615 PACIFIC ST STE 106, OMAHA, NE 68118-2187
(402) 933-4447
Mailing address
19009 MARCY ST APT 105, ELKHORN, NE 68022-4529
(402) 646-5588
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1942
NE
Other
Enumeration date
07/06/2017
Last updated
07/06/2017
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