Provider Demographics
NPI:1942295845
Name:BLUM, ALAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:BLUM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 JUTLAND DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3661
Mailing Address - Country:US
Mailing Address - Phone:619-688-2090
Mailing Address - Fax:619-688-2092
Practice Address - Street 1:4241 JUTLAND DR STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3661
Practice Address - Country:US
Practice Address - Phone:619-688-2090
Practice Address - Fax:619-688-2092
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2014-03-21
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CADC11407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC11407OtherSTATE LICENSE #
CADC11407OtherSTATE LICENSE #