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General NPI Number Information
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NPI Number | 1699905828
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Entity Type | Organization
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Legal Business Name | BLOOMINGTON SPORTS AND WELLNESS
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 07/22/2009
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Provider Practice Location Address
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Address Line | 806 N KEYSTONE CT
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City | BLOOMINGTON
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State | IN
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Zip | 47408-2823
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Country | US
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Telephone | 812-345-1446
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8456
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City | BLOOMINGTON
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State | IN
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Zip | 47407-8456
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN R MURER
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Credential | D.C.
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Telephone | 812-345-1446
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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 | 08002176A
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License Number State | IN
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