Provider Demographics
NPI:1215462932
Name:BAGGETT, BLAKE (DC)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:BAGGETT
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 1:917 MCFARLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3373
Mailing Address - Country:US
Mailing Address - Phone:205-523-4651
Mailing Address - Fax:205-377-7571
Practice Address - Street 1:917 MCFARLAND BLVD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3373
Practice Address - Country:US
Practice Address - Phone:205-523-4651
Practice Address - Fax:205-377-7571
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor