Individual
BLAKE KEITH STAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
46 SOUTH 18TH STREET, COLUMBIA, PA 17512
(717) 681-0198
Mailing address
1205 UNION STREET, LANCASTER, PA 17603
(563) 340-7872
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC009656
PA
Other
Enumeration date
07/31/2006
Last updated
07/08/2007
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