Provider Demographics
NPI:1033390752
Name:DANIEL R BLOHM DC PLC
Entity Type:Organization
Organization Name:DANIEL R BLOHM DC PLC
Other - Org Name:BLOHM CHIROPRACTIC HEALTH SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLOHM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-242-9122
Mailing Address - Street 1:326 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4436
Mailing Address - Country:US
Mailing Address - Phone:563-242-9122
Mailing Address - Fax:563-242-9122
Practice Address - Street 1:326 3RD AVE S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4436
Practice Address - Country:US
Practice Address - Phone:563-242-9122
Practice Address - Fax:563-242-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2109264Medicaid
IA1231514Medicaid
IA2005306Medicaid
IAI4598Medicare PIN
IAI4600Medicare PIN
IA2005306Medicaid