Provider Demographics
NPI:1043322837
Name:BLOOM, PAUL STEWART (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEWART
Last Name:BLOOM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 WHITACRE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1814
Mailing Address - Country:US
Mailing Address - Phone:608-833-3367
Mailing Address - Fax:608-833-3368
Practice Address - Street 1:7514 WHITACRE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1814
Practice Address - Country:US
Practice Address - Phone:608-833-3367
Practice Address - Fax:608-833-3368
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor