Provider Demographics
NPI:1962188987
Name:BLAZIO, JOSEPH III (DC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BLAZIO
Suffix:III
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 1:2600 S LOOP W STE 620
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2788
Mailing Address - Country:US
Mailing Address - Phone:713-661-7246
Mailing Address - Fax:713-661-7248
Practice Address - Street 1:2600 S LOOP W STE 620
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2788
Practice Address - Country:US
Practice Address - Phone:713-661-7246
Practice Address - Fax:713-661-7248
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty