Healthcare Provider Details

I. General information

NPI: 1770906182
Provider Name (Legal Business Name): AMBER BLOOM D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DATE ST APT 4004
HONOLULU HI
96826-5434
US

IV. Provider business mailing address

2525 DATE ST APT 4004
HONOLULU HI
96826-5434
US

V. Phone/Fax

Practice location:
  • Phone: 808-861-0494
  • Fax:
Mailing address:
  • Phone: 808-861-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-1575
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1788
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: