Provider Demographics
NPI:1992718670
Name:BLASCO, ANTHONY S JR (DC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:S
Last Name:BLASCO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W PUMPING
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951
Mailing Address - Country:US
Mailing Address - Phone:215-538-2380
Mailing Address - Fax:215-538-9783
Practice Address - Street 1:320 W PUMPING STATION RD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951
Practice Address - Country:US
Practice Address - Phone:215-538-2380
Practice Address - Fax:215-538-9783
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004472L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
638585OtherHIGHMARK BS
0829515OtherAETNA
638585OtherPERSONAL CHOICE
0483714000OtherKEYSTONE HEALTH PLAN EAST
0829515OtherAETNA