Provider Demographics
NPI:1447259908
Name:BLONG, DAVID M (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BLONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 BRADEN AVE
Mailing Address - Street 2:PO BOX 196
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1782
Mailing Address - Country:US
Mailing Address - Phone:641-774-5611
Mailing Address - Fax:641-774-5091
Practice Address - Street 1:927 BRADEN AVE
Practice Address - Street 2:
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049-1782
Practice Address - Country:US
Practice Address - Phone:641-774-5611
Practice Address - Fax:641-774-5091
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0270082Medicaid
27008OtherBLUE CROSS
T80080Medicare UPIN
IA27008Medicare PIN