Provider Demographics
NPI:1922123967
Name:STEPHEN M. BLUM, DC PA
Entity Type:Organization
Organization Name:STEPHEN M. BLUM, DC PA
Other - Org Name:BLUM CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-852-5888
Mailing Address - Street 1:9858 GLADES RD
Mailing Address - Street 2:SUITE D-4
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3982
Mailing Address - Country:US
Mailing Address - Phone:561-852-5888
Mailing Address - Fax:561-852-2202
Practice Address - Street 1:9858 GLADES RD
Practice Address - Street 2:SUITE D-4
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3982
Practice Address - Country:US
Practice Address - Phone:561-852-5888
Practice Address - Fax:561-852-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT95217Medicare UPIN
FL88383Medicare ID - Type Unspecified