Provider Demographics
NPI:1891883153
Name:BLUNK, DOUGLAS B (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
Last Name:BLUNK
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 1:1222 OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3717
Mailing Address - Country:US
Mailing Address - Phone:815-741-1352
Mailing Address - Fax:
Practice Address - Street 1:370 HOUBOLT RD
Practice Address - Street 2:SUITE #101
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:64031-8303
Practice Address - Country:US
Practice Address - Phone:815-741-9550
Practice Address - Fax:815-741-1735
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
K26725Medicare UPIN