Provider Demographics
NPI:1194823211
Name:DI BLASI, JAMES ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANTHONY
Last Name:DI BLASI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JIM
Other - Middle Name:A
Other - Last Name:DI BLASI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2487 CEDARCREST RD
Mailing Address - Street 2:SUITE 913
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2728
Mailing Address - Country:US
Mailing Address - Phone:770-974-2405
Mailing Address - Fax:770-974-5207
Practice Address - Street 1:2487 CEDARCREST RD
Practice Address - Street 2:SUITE 913
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-2728
Practice Address - Country:US
Practice Address - Phone:770-974-2405
Practice Address - Fax:770-974-5207
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU71047Medicare UPIN