Provider Demographics
NPI:1730629098
Name:BLANCHARD, CORY (DC)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:BLANCHARD
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 1:19685 PILOT KNOB RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7238
Mailing Address - Country:US
Mailing Address - Phone:651-478-6988
Mailing Address - Fax:651-478-6990
Practice Address - Street 1:19685 PILOT KNOB RD
Practice Address - Street 2:SUITE 260
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-7238
Practice Address - Country:US
Practice Address - Phone:651-478-6988
Practice Address - Fax:651-478-6990
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor