Provider Demographics
NPI:1699726398
Name:AMBRIDGE, F. BLAKE (DC,DACNB)
Entity type:Individual
Prefix:DR
First Name:F.
Middle Name:BLAKE
Last Name:AMBRIDGE
Suffix:
Gender:M
Credentials:DC,DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 W SUPERIOR ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2742
Mailing Address - Country:US
Mailing Address - Phone:208-946-5888
Mailing Address - Fax:208-920-6004
Practice Address - Street 1:1327 W SUPERIOR ST STE 103
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2742
Practice Address - Country:US
Practice Address - Phone:208-946-5888
Practice Address - Fax:208-920-6004
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1724111NN0400X
WACH61009706111NN0400X
CA19037111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU29246Medicare UPIN
CADC0190370Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION N