Dr Edward A Blanco, DC | |
12464 La Grange Rd, Louisville, KY 40245-1901 | |
(502) 205-2090 | |
(502) 205-2091 |
Full Name | Dr Edward A Blanco |
---|---|
Gender | Male |
Speciality | Chiropractic |
Experience | 25 Years |
Location | 12464 La Grange Rd, Louisville, Kentucky |
Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1013003771 | NPI | - | NPPES |
3970873 | Medicaid | TN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | DC0000001562 (Tennessee) | Secondary |
111N00000X | Chiropractor | 290033 (Kentucky) | Primary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Optimal Health Pllc | 4789840976 | 6 |
Optimal Medical Pllc | 6103275987 | 3 |
Provider Name | Optimal Health Pllc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1477812196 PECOS PAC ID: 4789840976 Enrollment ID: O20120716000060 |
Mailing Address | Practice Location Address |
---|---|
Dr Edward A Blanco, DC 12464 La Grange Rd, Louisville, KY 40245-1901 Ph: (502) 205-2090 | Dr Edward A Blanco, DC 12464 La Grange Rd, Louisville, KY 40245-1901 Ph: (502) 205-2090 |
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