Provider Demographics
NPI:1982265534
Name:BLUTH, JESS LELAND (DC)
Entity Type:Individual
Prefix:DR
First Name:JESS
Middle Name:LELAND
Last Name:BLUTH
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 1:1684 W REUNION AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4609
Mailing Address - Country:US
Mailing Address - Phone:801-562-0502
Mailing Address - Fax:801-302-8265
Practice Address - Street 1:1684 W REUNION AVE STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4609
Practice Address - Country:US
Practice Address - Phone:801-562-0502
Practice Address - Fax:801-302-8265
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9181282-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty