Healthcare Provider Details

I. General information

NPI: 1215134416
Provider Name (Legal Business Name): BLOOMVILLE CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 S MARION ST
BLOOMVILLE OH
44818-0236
US

IV. Provider business mailing address

PO BOX 236 53 S MARION ST
BLOOMVILLE OH
44818-0236
US

V. Phone/Fax

Practice location:
  • Phone: 419-983-2117
  • Fax:
Mailing address:
  • Phone: 419-983-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1578
License Number State

VIII. Authorized Official

Name: DR. RODNEY JAY LYNCH
Title or Position: CEO
Credential: DC
Phone: 419-983-2117