MEDICARE: DR. JORDAN BLAUSTEIN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH-11542	FL

General Provider Information

NPI Number	:	1659607026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN BLAUSTEIN DC

Provider Business Mailing Address
First Line	:	2717 SANTA BARBARA BLVD STE 7
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4432
Country	:	US
Telephone Number	:	239-984-9984
Fax Number	:	239-984-9986

Provider Business Practice Location Address
First Line	:	2717 SANTA BARBARA BLVD STE 7
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4432
Country	:	US
Telephone Number	:	623-984-9984
Fax Number	:	239-984-9986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	12/14/2018

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