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General NPI Number Information
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NPI Number | 1477730281
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Entity Type | Individual
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Provider Name | PETER G. BLUMENAUER DC
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Gender | Male
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 320 EAST BROADWAY SUITE 1C
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City | JACKSON
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State | WY
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Zip | 83001
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Country | US
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Telephone | 307-734-0222
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Fax | 307-734-0222
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Provider Business Mailing Address
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Address Line | PO BOX 12110
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City | JACKSON
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State | WY
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Zip | 83002-2110
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Country | US
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Telephone | 307-734-0222
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Fax | 307-734-0222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 605
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License Number State | WY
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