Provider Demographics
NPI:1336269190
Name:DEFLORES CHIROPRACTIC CLINICS PC
Entity Type:Organization
Organization Name:DEFLORES CHIROPRACTIC CLINICS PC
Other - Org Name:BLOSSOM CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:BLOSSOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-732-6780
Mailing Address - Street 1:5065 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1037
Mailing Address - Country:US
Mailing Address - Phone:810-732-6780
Mailing Address - Fax:810-733-7246
Practice Address - Street 1:5065 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1037
Practice Address - Country:US
Practice Address - Phone:810-732-6780
Practice Address - Fax:810-733-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2014-12-04
Deactivation Date:2007-12-28
Deactivation Code:
Reactivation Date:2008-01-30
Provider Licenses
StateLicense IDTaxonomies
MI2301002227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0005935508OtherAETNA
135332500OtherU.S. DEPARTMENT OF LABOR
GA350026642OtherRAILROAD MEDICARE
MI950B551410OtherBLUECROSSBLUESHIELD
MI1002107OtherMCLAREN HEALTHCARE
MI01003624OtherHEALTH PLUS
GACL4205OtherRAILROAD MEDICARE
MI950B551410OtherBLUECROSSBLUESHIELD
MI0P22490002Medicare ID - Type Unspecified