Provider Demographics
NPI:1619954005
Name:BLITSTEIN, WILLIAM MITCHELL (DC, FASA, CCSP)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MITCHELL
Last Name:BLITSTEIN
Suffix:
Gender:M
Credentials:DC, FASA, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 E WT HARRIS BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213
Mailing Address - Country:US
Mailing Address - Phone:704-921-0505
Mailing Address - Fax:704-921-0508
Practice Address - Street 1:2305 E WT HARRIS BLVD
Practice Address - Street 2:STE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213
Practice Address - Country:US
Practice Address - Phone:704-921-0505
Practice Address - Fax:704-921-0508
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2475111NS0005X
SCSC2487111NS0005X
3852171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0831XMedicaid
NC0831XMedicaid
U70473Medicare UPIN