MEDICARE: DR. FRED BLUM I D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X01155-1	NY

General Provider Information

NPI Number	:	1730368895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED BLUM I D.C.

Provider Business Mailing Address
First Line	:	153 MAIN ST.
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-3239
Country	:	US
Telephone Number	:	516-883-9355
Fax Number	:	516-883-9356

Provider Business Practice Location Address
First Line	:	153 MAIN ST
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-3239
Country	:	US
Telephone Number	:	516-883-9355
Fax Number	:	516-883-9356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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