Provider Demographics
NPI:1033375662
Name:BLUME, STACI JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:STACI
Middle Name:JEAN
Last Name:BLUME
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STACI
Other - Middle Name:JEAN
Other - Last Name:BORKHUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1350 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6452
Mailing Address - Country:US
Mailing Address - Phone:701-852-2800
Mailing Address - Fax:701-837-0175
Practice Address - Street 1:14297 BERGEN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3383
Practice Address - Country:US
Practice Address - Phone:317-674-8857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor