Provider Demographics
NPI:1891778601
Name:BLUM, MICHAEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BLUM
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:9601 PULASKI PARK DR
Mailing Address - Street 2:SUITE 416
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1409
Mailing Address - Country:US
Mailing Address - Phone:410-933-5678
Mailing Address - Fax:410-933-1823
Practice Address - Street 1:700 GEIPE RD
Practice Address - Street 2:SUITE 265
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4147
Practice Address - Country:US
Practice Address - Phone:410-747-7100
Practice Address - Fax:410-788-7387
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2015-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDS01786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1512551OtherCAQH
MD758649OtherCAREFIRST
MDU75350Medicare UPIN
MD1512551OtherCAQH