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General NPI Number Information
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NPI Number | 1265750046
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Entity Type | Organization
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Legal Business Name | BLOOMIN HEALTH CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 214 CENTER ST
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City | BLOOMSBURG
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State | PA
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Zip | 17815-1752
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Country | US
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Telephone | 570-204-9302
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Fax |
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Provider Business Mailing Address
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Address Line | 137 PEACOCK CORNERS RD
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City | BLOOMSBURG
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State | PA
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Zip | 17815-7202
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Country | US
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Telephone | 570-594-9693
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Fax |
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Authorized Official
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Title or Position | CO-OWNER, CHIROPRACTOR
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Name | DR. HANS WERNER BOTTESCH II
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Credential | D.C.
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Telephone | 570-594-9693
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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 | DC010201
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License Number State | PA
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