Provider Demographics
NPI:1346410123
Name:BLOOM, RICHARD M (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:BLOOM
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 1:100 RED SCHOOLHOUSE RD
Mailing Address - Street 2:7A
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-7049
Mailing Address - Country:US
Mailing Address - Phone:845-425-9575
Mailing Address - Fax:
Practice Address - Street 1:100 RED SCHOOLHOUSE RD
Practice Address - Street 2:7A
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-7049
Practice Address - Country:US
Practice Address - Phone:845-425-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor