Provider Demographics
NPI:1316489487
Name:NEAL B. BLAXBERG D.C. , LLC
Entity type:Organization
Organization Name:NEAL B. BLAXBERG D.C. , LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZIPPORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-484-0666
Mailing Address - Street 1:7 CHURCH LN
Mailing Address - Street 2:SUITE 12
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3710
Mailing Address - Country:US
Mailing Address - Phone:410-484-0666
Mailing Address - Fax:
Practice Address - Street 1:7 CHURCH LN
Practice Address - Street 2:SUITE 12
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3710
Practice Address - Country:US
Practice Address - Phone:410-484-0666
Practice Address - Fax:410-486-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03606111N00000X
MD01269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407753Medicare PIN