Healthcare Provider Details

I. General information

NPI: 1851430581
Provider Name (Legal Business Name): JEFFREY S BLOOM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E GRAND AVE
ESCONDIDO CA
92025-4402
US

IV. Provider business mailing address

633 E GRAND AVE
ESCONDIDO CA
92025-4402
US

V. Phone/Fax

Practice location:
  • Phone: 760-747-4737
  • Fax: 760-747-9905
Mailing address:
  • Phone: 760-747-4737
  • Fax: 760-747-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC20522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: