Provider Demographics
NPI:1346295789
Name:BLETZINGER, JOSHUA JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JAY
Last Name:BLETZINGER
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 1:1605 W WILSON ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1627
Mailing Address - Country:US
Mailing Address - Phone:630-761-9702
Mailing Address - Fax:630-444-1855
Practice Address - Street 1:1605 W WILSON ST
Practice Address - Street 2:SUITE 114
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1627
Practice Address - Country:US
Practice Address - Phone:630-761-9702
Practice Address - Fax:630-444-1855
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor