Provider Demographics
NPI:1073634333
Name:BLOSSOMLAND CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:BLOSSOMLAND CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRILLWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-983-8989
Mailing Address - Street 1:712 COMINGS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1943
Mailing Address - Country:US
Mailing Address - Phone:269-983-8989
Mailing Address - Fax:269-983-1875
Practice Address - Street 1:712 COMINGS AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1943
Practice Address - Country:US
Practice Address - Phone:269-983-8989
Practice Address - Fax:269-983-1875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty