Provider Demographics
NPI:1962280388
Name:BLAKE, SAVANNAH (DC)
Entity type:Individual
Prefix:DR
First Name:SAVANNAH
Middle Name:
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 1:3921 W RIVER DR STE 7
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5736
Mailing Address - Country:US
Mailing Address - Phone:361-654-4747
Mailing Address - Fax:361-654-4750
Practice Address - Street 1:3921 W RIVER DR STE 7
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5736
Practice Address - Country:US
Practice Address - Phone:361-654-4747
Practice Address - Fax:361-654-4750
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
TX15753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist