Provider Demographics
NPI:1588089312
Name:BLEDSOE, DUSTIN RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:RYAN
Last Name:BLEDSOE
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 1:2740-1 CAPITAL CIRCLE N.E.
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4108
Mailing Address - Country:US
Mailing Address - Phone:850-386-8282
Mailing Address - Fax:850-386-7184
Practice Address - Street 1:2740 CAPITAL CIR NE STE 1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4108
Practice Address - Country:US
Practice Address - Phone:850-386-8282
Practice Address - Fax:850-386-7184
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor