Provider Demographics
NPI:1184604555
Name:BLOMERTH, PAUL RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:BLOMERTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:77 WINSOR ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-3469
Mailing Address - Country:US
Mailing Address - Phone:413-583-8326
Mailing Address - Fax:413-583-6133
Practice Address - Street 1:77 WINSOR ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3469
Practice Address - Country:US
Practice Address - Phone:413-583-8326
Practice Address - Fax:413-583-6133
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2013-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA0000835111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1611968Medicaid
MAY35581Medicare PIN
MA1611968Medicaid