Provider Demographics
NPI:1386130839
Name:BLAKE, CAMEON MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:CAMEON
Middle Name:MICHELLE
Last Name:BLAKE
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 1:12482 SLATER LN
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1773
Mailing Address - Country:US
Mailing Address - Phone:913-475-5193
Mailing Address - Fax:
Practice Address - Street 1:1707 E CEDAR ST STE 108
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1886
Practice Address - Country:US
Practice Address - Phone:913-475-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor