Provider Demographics
NPI:1336148253
Name:BLAUM, JAMES GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GERARD
Last Name:BLAUM
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 1:105 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1209
Mailing Address - Country:US
Mailing Address - Phone:570-287-3090
Mailing Address - Fax:570-287-3060
Practice Address - Street 1:105 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1209
Practice Address - Country:US
Practice Address - Phone:570-287-3090
Practice Address - Fax:570-287-3060
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-4283-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015554030002Medicaid
PA4600484OtherUS HEALTHCARE #
PABL-716219OtherBLUE SHIELD #
PA805858OtherFIRST PRIORITY/BLUE CARE
PABL-716219OtherBLUE SHIELD #
PAU01481Medicare UPIN