Provider Demographics
NPI:1194858175
Name:BLUM, ROBERT MICHAEL (DC, PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:BLUM
Suffix:
Gender:M
Credentials:DC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 CATASAUQUA RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7401
Mailing Address - Country:US
Mailing Address - Phone:610-419-1532
Mailing Address - Fax:610-317-0167
Practice Address - Street 1:1343 CATASAUQUA RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7401
Practice Address - Country:US
Practice Address - Phone:610-419-1532
Practice Address - Fax:610-317-0167
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007242-L111N00000X
PAAJ-007242-L111N00000X
NYX007768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA354834OtherBS PROVIDER #
NYC07768-7OtherNY WORK COMP PROVIDER #
PA354834OtherBS PROVIDER #
PA016131Medicare ID - Type Unspecified
NYC07768-7OtherNY WORK COMP PROVIDER #
PAU65499Medicare UPIN