Individual
GARY P BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
26751 SOUTHFIELD RD, LATHRUP VILLAGE, MI 48076-4532
(248) 552-0510
Mailing address
1210 SMITH AVE, ROYAL OAK, MI 48073-3190
(313) 319-3033
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301007072
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F33395
BCBS
MI
Enumeration date
10/02/2006
Last updated
07/08/2007
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