Provider Demographics
NPI:1700986320
Name:BLEECKER, JAMES S (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:BLEECKER
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 1:340 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PROPHETSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:61277-1115
Mailing Address - Country:US
Mailing Address - Phone:815-537-2226
Mailing Address - Fax:815-537-5811
Practice Address - Street 1:340 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PROPHETSTOWN
Practice Address - State:IL
Practice Address - Zip Code:61277-1115
Practice Address - Country:US
Practice Address - Phone:815-537-2226
Practice Address - Fax:815-537-5811
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL20-9275Medicare ID - Type Unspecified
U67799Medicare UPIN