1982876330 NPI number — BLUME FAMILY CHIROPRACTIC & MASSAGE, INC

Table of content: (NPI 1982876330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982876330 NPI number — BLUME FAMILY CHIROPRACTIC & MASSAGE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUME FAMILY CHIROPRACTIC & MASSAGE, INC
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:
1982876330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1611 KRESKY AVE, SUITE108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRALIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98531-8982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-330-1800
Provider Business Mailing Address Fax Number:
360-330-5866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 KRESKY AVE STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98531-8982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-330-1800
Provider Business Practice Location Address Fax Number:
360-330-5866
Provider Enumeration Date:
03/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BLUME
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-330-1800

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0254923 . This is a "WASHINGTON STATE DEPT OF LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com