Provider Demographics
NPI:1366542581
Name:BLACKWOOD CHIROPRACTIC CLINIC P A
Entity type:Organization
Organization Name:BLACKWOOD CHIROPRACTIC CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-243-4049
Mailing Address - Street 1:511 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-2111
Mailing Address - Country:US
Mailing Address - Phone:785-243-4049
Mailing Address - Fax:785-243-4735
Practice Address - Street 1:511 CEDAR ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-2111
Practice Address - Country:US
Practice Address - Phone:785-243-4049
Practice Address - Fax:785-243-4735
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACKWOOD CHIROPRACTIC CLINIC P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty