Provider Demographics
NPI:1881062156
Name:BLODGETT, MICHAEL ALVAH (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALVAH
Last Name:BLODGETT
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 1:555 S MIDVALE BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1419
Mailing Address - Country:US
Mailing Address - Phone:608-292-4466
Mailing Address - Fax:
Practice Address - Street 1:555 S MIDVALE BLVD STE 113
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1419
Practice Address - Country:US
Practice Address - Phone:608-292-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12-5107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor