Provider Demographics
NPI:1437216801
Name:BLEIL, JAY JERALD (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:JERALD
Last Name:BLEIL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JERALD
Other - Middle Name:JAY
Other - Last Name:BLEIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:616 2ND ST
Mailing Address - Street 2:
Mailing Address - City:IDA GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:51445-1012
Mailing Address - Country:US
Mailing Address - Phone:712-364-2508
Mailing Address - Fax:712-364-2198
Practice Address - Street 1:616 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445-1012
Practice Address - Country:US
Practice Address - Phone:712-364-2508
Practice Address - Fax:712-364-2198
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA 05698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1104497Medicaid
IA1104497Medicaid