Healthcare Provider Details

I. General information

NPI: 1215055801
Provider Name (Legal Business Name): THUMPER BLOOMQUIST D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W VICTORY BLVD SUITE E
BURBANK CA
91506-1256
US

IV. Provider business mailing address

2300 W. VICTORY BLVD SUITE E
BURBANK CA
91506-1200
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-9600
  • Fax: 208-275-2137
Mailing address:
  • Phone: 818-848-9600
  • Fax: 208-275-2137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number013939
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number013939
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number013939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: