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General NPI Number Information
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NPI Number | 1003260159
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Entity Type | Organization
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Legal Business Name | BLOOM CHIROPRACTIC & WELLNESS CENTER
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 4061 BELLAIRE BLVD SUITE A
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City | HOUSTON
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State | TX
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Zip | 77025-1121
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Country | US
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Telephone | 832-930-2261
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Fax | 504-323-5832
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Provider Business Mailing Address
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Address Line | 4061 BELLAIRE BLVD SUITE A
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City | HOUSTON
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State | TX
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Zip | 77025-1121
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Country | US
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Telephone | 832-930-2261
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Fax | 504-323-5832
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Authorized Official
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Title or Position | MEMBER
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Name | DR. AMBER DAWN BLOOM
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Credential | D.C.
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Telephone | 832-930-2261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 12513
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License Number State | TX
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