Provider Demographics
NPI:1568231827
Name:BLOOM CHIROPRACTIC CO PLLC
Entity Type:Organization
Organization Name:BLOOM CHIROPRACTIC CO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-650-1662
Mailing Address - Street 1:7300 WESTOWN PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2527
Mailing Address - Country:US
Mailing Address - Phone:515-650-1662
Mailing Address - Fax:
Practice Address - Street 1:7300 WESTOWN PKWY STE 210
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-2527
Practice Address - Country:US
Practice Address - Phone:515-650-1662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty