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General NPI Number Information
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NPI Number | 1013353275
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Entity Type | Organization
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Legal Business Name | BLOOM FAMILY CHIROPRACTIC INC
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 633 E GRAND AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-4402
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Country | US
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Telephone | 760-747-4737
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Fax | 760-747-9905
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Provider Business Mailing Address
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Address Line | 633 E GRAND AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-4402
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Country | US
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Telephone | 760-747-4737
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Fax | 760-747-9905
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | TERESA L GUTA
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Credential | DC
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Telephone | 760-747-4737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC21341
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC20522
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License Number State | CA
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