Healthcare Provider Details

I. General information

NPI: 1346295789
Provider Name (Legal Business Name): JOSHUA JAY BLETZINGER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 W WILSON ST SUITE 114
BATAVIA IL
60510-1627
US

IV. Provider business mailing address

1605 W WILSON ST SUITE 114
BATAVIA IL
60510-1627
US

V. Phone/Fax

Practice location:
  • Phone: 630-761-9702
  • Fax: 630-444-1855
Mailing address:
  • Phone: 630-761-9702
  • Fax: 630-444-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-010143
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: