Provider Demographics
NPI:1659607026
Name:BLAUSTEIN, JORDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:BLAUSTEIN
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 1:2717 SANTA BARBARA BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4432
Mailing Address - Country:US
Mailing Address - Phone:239-984-9984
Mailing Address - Fax:239-984-9986
Practice Address - Street 1:2717 SANTA BARBARA BLVD STE 7
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4432
Practice Address - Country:US
Practice Address - Phone:623-984-9984
Practice Address - Fax:239-984-9986
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-11542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor