Provider Demographics
NPI:1043518822
Name:BLAHA, JONATHAN E (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:E
Last Name:BLAHA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E. ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521
Mailing Address - Country:US
Mailing Address - Phone:970-639-9730
Mailing Address - Fax:970-639-2750
Practice Address - Street 1:212 E. ASPEN AVE
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521
Practice Address - Country:US
Practice Address - Phone:970-639-9730
Practice Address - Fax:970-639-2750
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1656111N00000X
COCHR.006988111N00000X
COCHR.0006988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor