Provider Demographics
NPI:1063693901
Name:BLIND, LYNNE ANNETTE (DC)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:ANNETTE
Last Name:BLIND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 E 52ND ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2700
Mailing Address - Country:US
Mailing Address - Phone:563-344-4926
Mailing Address - Fax:563-344-8759
Practice Address - Street 1:2210 E 52ND ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2700
Practice Address - Country:US
Practice Address - Phone:563-344-4926
Practice Address - Fax:563-344-8759
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor