Healthcare Provider Details

I. General information

NPI: 1912213216
Provider Name (Legal Business Name): CLAYTON JOHN BLANCHETTE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3028 E 4000N RD
BOURBONNAIS IL
60914-4089
US

IV. Provider business mailing address

3028 E 4000N RD
BOURBONNAIS IL
60914-4089
US

V. Phone/Fax

Practice location:
  • Phone: 646-598-2055
  • Fax:
Mailing address:
  • Phone: 646-598-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.011685
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: