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General NPI Number Information
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NPI Number | 1063677698
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Entity Type | Organization
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Legal Business Name | DANIEL E BLOSSOM, P C
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 811 W HURON AVE
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City | VASSAR
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State | MI
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Zip | 48768-1128
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Country | US
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Telephone | 989-823-7076
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Fax | 989-823-3390
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Provider Business Mailing Address
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Address Line | 811 W HURON AVE
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City | VASSAR
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State | MI
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Zip | 48768-1128
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Country | US
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Telephone | 989-823-7076
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Fax | 989-823-3390
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL ERWIN BLOSSOM
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Credential | D. C.
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Telephone | 989-823-7076
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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 | DB004810
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License Number State | MI
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