Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Blake Robert Pennock II, DC

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1053877159

Dr. Blake Robert Pennock II, DC is a Student in an Organized Health Care Education/Training Program in Flagstaff, Arizona. Practices as a sole proprietor. Licensed in Arizona.

Licensed in
AZ
In the registry since
2019
Specialties on file
2
What do these letters mean?
DC — Doctor of Chiropractic
A licensed chiropractor.

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Practice location Address checks out

1501 S Yale St Ste 250
Flagstaff, AZ 86001-7336
Phone: (928) 557-0707
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Chiropractor (primary) Taxonomy 111N00000X · Licence 8787 (AZ)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1053877159
Entity typeIndividual (Type 1)
GenderMale
Credentials DC
Sole proprietorYes
NPI enumeratedFebruary 13, 2019
Last updated in NPPESFebruary 22, 2019
Mailing address505 W Baseline Rd Apt 2142, Tempe, AZ 85283-5319

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