William Mitchell Blitstein, DC, FASA, CCSP

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

NC2475 Issued in NC

Practice address

2305 E WT Harris Blvd
Ste 102
Charlotte, NC 28213

Phone

(704) 921-0505

Fax

(704) 921-0508

NPI assigned

Dec 27, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vitality Chiropractic & Acupuncture, PLLC

  • Chiropractor
  • Charlotte, NC
  • NPI 1710877261
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357689600000",
    "number": "1619954005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 E WT HARRIS BLVD",
            "address_2": "STE 102",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28213",
            "telephone_number": "704-921-0505",
            "fax_number": "704-921-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 E WT HARRIS BLVD",
            "address_2": "STE 102",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28213",
            "telephone_number": "704-921-0505",
            "fax_number": "704-921-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLITSTEIN",
        "first_name": "WILLIAM",
        "middle_name": "MITCHELL",
        "name_prefix": "Dr.",
        "credential": "DC, FASA, CCSP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2013-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "NC",
            "license": "NC2475",
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "SC",
            "license": "SC2487",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": null,
            "license": "3852",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0831X",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blissfull Living Care LLC
• Blissfully Supported Enterprises Inc
• Blissfully Supported LLC
• Maxwell Blitstein, D.C
• Michelle Lila Blitstein, M.S. R.D.
• Annalisa Block
• Jared G Block, M.D.
• Courtney Vann Blocker, FNP-C
• Michael Edward Blocker, M.D.
• Naomi L Blocton, MS, RD, LDN

• All providers in Charlotte, NC
• Sports Physician Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.