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General NPI Number Information
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NPI Number | 1508720517
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Entity Type | Organization
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Legal Business Name | BLOOM SANCTUARY PLLC
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Dates
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Enumeration Date | 12/13/2025
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 136 W LANCASTER AVE STE 2
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City | PAOLI
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State | PA
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Zip | 19301-1786
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Country | US
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Telephone | 610-822-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 136 W LANCASTER AVE STE 2
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City | PAOLI
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State | PA
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Zip | 19301-1786
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Country | US
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Telephone | 610-822-0044
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. BRANDIE ELIZABETH KEATES
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Credential | DC
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Telephone | 610-864-9098
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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 |
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License Number State |
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