Provider Demographics
NPI:1053883363
Name:BLAUSTEIN CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:BLAUSTEIN CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAUSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-984-9984
Mailing Address - Street 1:2717 SANTA BARBARA BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4432
Mailing Address - Country:US
Mailing Address - Phone:123-998-4998
Mailing Address - Fax:239-984-9986
Practice Address - Street 1:2717 SANTA BARBARA BLVD STE 7
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4432
Practice Address - Country:US
Practice Address - Phone:123-998-4998
Practice Address - Fax:239-984-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-27
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty