Provider Demographics
NPI:1598170128
Name:BLOOM CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:BLOOM CHIROPRACTIC, PLLC
Other - Org Name:BLOOM CHIROPRACTIC AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-387-9876
Mailing Address - Street 1:9415 MCNEIL DR. #718
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750
Mailing Address - Country:US
Mailing Address - Phone:469-387-9876
Mailing Address - Fax:
Practice Address - Street 1:9415 MCNEIL DR APT 718
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8562
Practice Address - Country:US
Practice Address - Phone:469-387-9876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty