Provider Demographics
NPI:1609182245
Name:DR TONY BLEVINS CHIROPRACTIC CENTERS LLC
Entity type:Organization
Organization Name:DR TONY BLEVINS CHIROPRACTIC CENTERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-474-9777
Mailing Address - Street 1:1430 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1005
Mailing Address - Country:US
Mailing Address - Phone:740-474-9777
Mailing Address - Fax:740-474-6225
Practice Address - Street 1:1430 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1005
Practice Address - Country:US
Practice Address - Phone:740-474-9777
Practice Address - Fax:740-474-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3234111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU89073Medicare UPIN