Provider Demographics
NPI:1104866730
Name:BLOODWORTH, JOHN G (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:BLOODWORTH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:4105 METROPOLITAN PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-7503
Mailing Address - Country:US
Mailing Address - Phone:586-939-1003
Mailing Address - Fax:586-939-3862
Practice Address - Street 1:4105 METROPOLITAN PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310-7503
Practice Address - Country:US
Practice Address - Phone:586-939-1003
Practice Address - Fax:586-939-3862
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2301007508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor