Healthcare Provider Details

I. General information

NPI: 1871548859
Provider Name (Legal Business Name): PERFORMANCE CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

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 Code305R00000X
TaxonomyPreferred Provider Organization
License Number038-010143
License Number StateIL

VIII. Authorized Official

Name: DR. JOSHUA JAY BLETZINGER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 630-761-9702