Provider Demographics
NPI:1275635039
Name:BLUM, JOHN W (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:BLUM
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 1:1302 STONEBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103
Mailing Address - Country:US
Mailing Address - Phone:630-830-1966
Mailing Address - Fax:630-830-3294
Practice Address - Street 1:601 SOUTH ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHARMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3122
Practice Address - Country:US
Practice Address - Phone:847-584-2225
Practice Address - Fax:847-584-2246
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
558140Medicare ID - Type Unspecified