Provider Demographics
NPI:1891908539
Name:BLUECHIP INITIATIVE INC
Entity Type:Organization
Organization Name:BLUECHIP INITIATIVE INC
Other - Org Name:RAVENNA CHIROPRACTIC & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DUSTIN
Authorized Official - Last Name:BLUETER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-297-9797
Mailing Address - Street 1:6693 N CHESTNUT ST
Mailing Address - Street 2:128
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3922
Mailing Address - Country:US
Mailing Address - Phone:330-297-9797
Mailing Address - Fax:330-296-2329
Practice Address - Street 1:6693 N CHESTNUT ST
Practice Address - Street 2:128
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3922
Practice Address - Country:US
Practice Address - Phone:330-297-9797
Practice Address - Fax:330-296-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3483111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2672728Medicaid
OHDA9286841Medicare ID - Type Unspecified
OH2672728Medicaid