Healthcare Provider Details

I. General information

NPI: 1790641231
Provider Name (Legal Business Name): BLOOM WELLNESS & CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13049 W LINEBAUGH AVE STE 102
TAMPA FL
33626-4488
US

IV. Provider business mailing address

13049 W LINEBAUGH AVE STE 102
TAMPA FL
33626-4488
US

V. Phone/Fax

Practice location:
  • Phone: 813-461-3355
  • Fax:
Mailing address:
  • Phone: 813-461-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXA ELIZABETH VALDEZ
Title or Position: OWNER
Credential: DC, LM
Phone: 813-461-3355