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Individual

DR. JERRY DEAN BLANCHARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CHIROPRACTOR

Contact information

Practice address
631 W 12TH STREET, GRAFTON, ND 58237-0185
(701) 352-1690
(701) 352-2258
Mailing address
PO BOX 185, GRAFTON, ND 58237-0185
(701) 352-1690
(701) 352-2258

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
311
ND
111NX0800X
Orthopedic Chiropractor
1610
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10544
ND
01
4232
BLUE SHIELD NORTH DAKOTA
ND
01
8Z546BL
BLUE SHIELD MINNESOTA
MN
Enumeration date
11/28/2006
Last updated
10/04/2007
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