Provider Demographics
NPI:1205354891
Name:BLONN, DAVID ALAN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:BLONN
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 1:112 SILVER QUEEN LN
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-8437
Mailing Address - Country:US
Mailing Address - Phone:630-589-4370
Mailing Address - Fax:
Practice Address - Street 1:921 LEJEUNE BLVD # B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5916
Practice Address - Country:US
Practice Address - Phone:630-589-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-02
Last Update Date:2017-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAC-851171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist