Provider Demographics
NPI:1306874755
Name:BLACKFORD, AMBER R (DC)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:R
Last Name:BLACKFORD
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 1:701 HIGHLAND SPRINGS AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2550
Mailing Address - Country:US
Mailing Address - Phone:951-845-9183
Mailing Address - Fax:951-845-9193
Practice Address - Street 1:701 HIGHLAND SPRINGS AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2550
Practice Address - Country:US
Practice Address - Phone:951-845-9183
Practice Address - Fax:951-845-9193
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 27013OtherBLUE CROSS, ASHP
CADC0270130OtherBLUE SHIELD
CADC0270130Medicaid
CAP00087251OtherRAILROAD MEDICARE
CADC0270130Medicare ID - Type Unspecified