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General NPI Number Information
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NPI Number | 1043434822
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Entity Type | Organization
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Legal Business Name | BLUM LTD
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 10 N ROSELLE RD # 300
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City | ROSELLE
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State | IL
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Zip | 60172-1592
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Country | US
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Telephone | 630-351-4700
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Fax | 630-351-9206
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Provider Business Mailing Address
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Address Line | 10 N ROSELLE RD # 300
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City | ROSELLE
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State | IL
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Zip | 60172-1592
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Country | US
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Telephone | 630-351-4700
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Fax | 630-351-9206
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JOHN W BLUM
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Credential | DC
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Telephone | 630-351-4700
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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 | 038007783
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License Number State | IL
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