Provider Demographics
NPI:1538659453
Name:BLOOMBERG, JON LUKE (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:LUKE
Last Name:BLOOMBERG
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 1:1905 W JOURDAN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IL
Mailing Address - Zip Code:62448-2025
Mailing Address - Country:US
Mailing Address - Phone:618-783-2424
Mailing Address - Fax:618-783-8457
Practice Address - Street 1:2977 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2650
Practice Address - Country:US
Practice Address - Phone:614-275-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor