Provider Demographics
NPI:1194158014
Name:BLOWERS, BLAKE JENNINGS
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:JENNINGS
Last Name:BLOWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 LOCKPORT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1225
Mailing Address - Country:US
Mailing Address - Phone:701-223-8873
Mailing Address - Fax:701-223-1014
Practice Address - Street 1:3712 LOCKPORT ST
Practice Address - Street 2:SUITE B
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1225
Practice Address - Country:US
Practice Address - Phone:701-223-8873
Practice Address - Fax:701-223-1014
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT217171100000X
CO1416171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist