Provider Demographics
NPI:1992802011
Name:BLAKER, WILLIAM KEEN (DC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KEEN
Last Name:BLAKER
Suffix:
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 1:2018 ROCK SPRING RD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2631
Mailing Address - Country:US
Mailing Address - Phone:410-879-0400
Mailing Address - Fax:410-879-0494
Practice Address - Street 1:2018 ROCK SPRING RD
Practice Address - Street 2:SUITE #7
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2631
Practice Address - Country:US
Practice Address - Phone:410-879-0400
Practice Address - Fax:410-879-0494
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT090OtherFEDERAL BCBS
MDM079WKOtherBLUE CROSS BLUE SHIELD
MDT090OtherFEDERAL BCBS