Provider Demographics
NPI:1629186101
Name:BLUETER, WILLIAM DUSTIN (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DUSTIN
Last Name:BLUETER
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 1:6693 N CHESTNUT ST
Mailing Address - Street 2:SUITE 128
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3922
Mailing Address - Country:US
Mailing Address - Phone:330-297-9797
Mailing Address - Fax:330-296-2329
Practice Address - Street 1:6693 N CHESTNUT ST
Practice Address - Street 2:SUITE 128
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3922
Practice Address - Country:US
Practice Address - Phone:330-297-9797
Practice Address - Fax:330-296-2329
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000323264OtherANTHEM BCBS
OH665061OtherUNITEDHEALTH CARE
OH7011533OtherAETNA
OHWB341321738OtherSUMMACARE
OH000000323264OtherANTHEM BCBS
OH665061OtherUNITEDHEALTH CARE