Provider Demographics
NPI:1811185713
Name:BLUM HEALTH LLC
Entity Type:Organization
Organization Name:BLUM HEALTH LLC
Other - Org Name:GENERATION CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-584-2438
Mailing Address - Street 1:12025 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-288-8400
Mailing Address - Fax:904-288-9888
Practice Address - Street 1:12025 SAN JOSE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-288-8400
Practice Address - Fax:904-288-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9336111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA1631Medicare PIN