Healthcare Provider Details

I. General information

NPI: 1538352356
Provider Name (Legal Business Name): BLUM CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31360 VIA COLINAS STE 104
WESTLAKE VILLAGE CA
91362-6821
US

IV. Provider business mailing address

31360 VIA COLINAS STE 104
WESTLAKE VILLAGE CA
91362-6821
US

V. Phone/Fax

Practice location:
  • Phone: 805-492-1500
  • Fax: 805-492-1504
Mailing address:
  • Phone: 805-492-1500
  • Fax: 805-492-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27014
License Number StateCA

VIII. Authorized Official

Name: ERIC BLUM
Title or Position: OWNER/PRACTIONER
Credential: DC27014
Phone: 805-492-1500