Provider Demographics
NPI:1831469998
Name:BLEEM FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BLEEM FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENOLD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLEEM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-543-4341
Mailing Address - Street 1:314 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-1140
Mailing Address - Country:US
Mailing Address - Phone:309-543-4341
Mailing Address - Fax:309-543-4321
Practice Address - Street 1:314 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-1140
Practice Address - Country:US
Practice Address - Phone:309-543-4341
Practice Address - Fax:309-543-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU60548Medicare UPIN