Provider Demographics
NPI:1225078785
Name:BLUMENFELD, FRED C (DC)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:C
Last Name:BLUMENFELD
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 1:4676 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4624
Mailing Address - Country:US
Mailing Address - Phone:561-684-0710
Mailing Address - Fax:561-689-7571
Practice Address - Street 1:4676 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4624
Practice Address - Country:US
Practice Address - Phone:561-684-0710
Practice Address - Fax:561-689-7571
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL607072800OtherOWCP
FL5806220OtherGHI
FL88144OtherBLUE CROSS BLUE SHIELD
FL5806220OtherGHI
FLU13043Medicare UPIN