Healthcare Provider Details

I. General information

NPI: 1750916995
Provider Name (Legal Business Name): BARBARA ELISABET BLOOMQUIST DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 11/27/2023
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3363 HIGHWAY 14
MILLBROOK AL
36054-2424
US

IV. Provider business mailing address

6770 SPRING VALLEY DR
ELMORE AL
36025-2026
US

V. Phone/Fax

Practice location:
  • Phone: 334-285-8483
  • Fax: 844-654-7165
Mailing address:
  • Phone: 334-652-2660
  • Fax: 844-654-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2636
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: