1902948359 NPI number — PAUL R. BLOMERTH, D.C.

Table of content: (NPI 1902948359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902948359 NPI number — PAUL R. BLOMERTH, D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL R. BLOMERTH, D.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902948359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 WINSOR ST
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
LUDLOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01056-3469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-583-0832
Provider Business Mailing Address Fax Number:
413-583-6133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 WINSOR ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LUDLOW
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01056-3469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-583-0832
Provider Business Practice Location Address Fax Number:
413-583-6133
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLOMERTH
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
413-583-8326

Provider Taxonomy Codes

  • Taxonomy code: 111NN0400X , with the licence number:  0000835 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y39115 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1611968 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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