Healthcare Provider Details

I. General information

NPI: 1487812350
Provider Name (Legal Business Name): CHARLES L. BLUM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 NATIONAL BLVD STE 117
LOS ANGELES CA
90064-3902
US

IV. Provider business mailing address

11209 NATIONAL BLVD STE 117
LOS ANGELES CA
90064-3902
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-9799
  • Fax:
Mailing address:
  • Phone: 310-392-9799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: