Provider Demographics
NPI:1760900450
Name:BLOOM, ASHLEY RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:RAE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:CURWENSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16833-1115
Mailing Address - Country:US
Mailing Address - Phone:814-592-8380
Mailing Address - Fax:
Practice Address - Street 1:407 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:CURWENSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16833-1115
Practice Address - Country:US
Practice Address - Phone:814-592-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-02
Last Update Date:2017-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor