Provider Demographics
NPI:1407184120
Name:BLOOMFIELD CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BLOOMFIELD CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOMFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-696-8169
Mailing Address - Street 1:110 SANBORN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1770
Mailing Address - Country:US
Mailing Address - Phone:231-629-8556
Mailing Address - Fax:
Practice Address - Street 1:110 SANBORN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1770
Practice Address - Country:US
Practice Address - Phone:231-629-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty