| |
2316 Pulaski Hwy Ste B, North East, MD 21901-3730 | |
(410) 642-9110 | |
(410) 642-9113 |
Full Name | |
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Type | Facility |
Speciality | Chiropractor |
Location | 2316 Pulaski Hwy Ste B, North East, Maryland |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1740405604 | NPI | - | NPPES |
61670301 | Other | MD | BC RENDERING PROV. ID |
2912304 | Other | MD | AETNA PROV. ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 02079 (Maryland) | Primary |
225100000X | Physical Therapist | 02079 (Maryland) | Secondary |
Provider Name | Heather M Blackiston |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1619926623 PECOS PAC ID: 9335224138 Enrollment ID: I20101026000965 |
Mailing Address | Practice Location Address |
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2316 Pulaski Hwy Ste B, North East, MD 21901-3730 Ph: (410) 642-9110 | 2316 Pulaski Hwy Ste B, North East, MD 21901-3730 Ph: (410) 642-9110 |
Dr. Heather Mccoy Blackiston, DC Chiropractor Medicare: May Accept Medicare Assignments Practice Location: 2316 Pulaski Hwy Ste B, North East, MD 21901 Phone: 410-642-9110 Fax: 410-642-9113 |