Individual
DR. BLAKE DANTON CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
6573 OLD JACKSONVILLE HWY STE 100, TYLER, TX 75703-0722
(903) 617-6106
(903) 617-6857
Mailing address
16104 BUCKBOARD CIR, TYLER, TX 75703-7504
(903) 316-4517
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
13869
TX
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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