Provider Demographics
NPI:1497851877
Name:BLESCH, FREDERICK M (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:M
Last Name:BLESCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 S SHIELDS ST
Mailing Address - Street 2:BLDG D STE 204
Mailing Address - City:FORT COLLINS,
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1888
Mailing Address - Country:US
Mailing Address - Phone:970-495-6899
Mailing Address - Fax:970-495-0139
Practice Address - Street 1:2001 S SHIELDS ST
Practice Address - Street 2:BLDG D STE 204
Practice Address - City:FORT COLLINS,
Practice Address - State:CO
Practice Address - Zip Code:80526-1888
Practice Address - Country:US
Practice Address - Phone:970-495-6899
Practice Address - Fax:970-495-0139
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21673Medicare UPIN