Provider Demographics
NPI:1982848115
Name:BLITZSTEIN, BRETT (DC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:BLITZSTEIN
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 1:830 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1724
Mailing Address - Country:US
Mailing Address - Phone:937-645-9000
Mailing Address - Fax:937-645-9000
Practice Address - Street 1:830 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1724
Practice Address - Country:US
Practice Address - Phone:937-645-9000
Practice Address - Fax:937-645-9000
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC3358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor