Provider Demographics
NPI:1326315730
Name:THOMAS E BLOINK A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:THOMAS E BLOINK A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:CALIFORNIA CRANIAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLOINK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-395-8006
Mailing Address - Street 1:431 MONTEREY AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5319
Mailing Address - Country:US
Mailing Address - Phone:408-395-8006
Mailing Address - Fax:408-395-7317
Practice Address - Street 1:431 MONTEREY AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5319
Practice Address - Country:US
Practice Address - Phone:408-395-8006
Practice Address - Fax:408-395-7317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty