Provider Demographics
NPI:1770696700
Name:BLOMERTH CHIROPRACTIC
Entity type:Organization
Organization Name:BLOMERTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLOMERTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-535-6155
Mailing Address - Street 1:215 NEWBURY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2414
Mailing Address - Country:US
Mailing Address - Phone:978-535-6155
Mailing Address - Fax:978-535-1685
Practice Address - Street 1:215 NEWBURY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2414
Practice Address - Country:US
Practice Address - Phone:978-535-6155
Practice Address - Fax:978-535-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39393OtherBLUE CROSS BLUE SHIELD MA
MAY35513OtherBLUE CROSS BLUE SHIELD MA
MAY35601OtherBLUE CROSS BLUE SHIELD
MAY39393OtherBLUE CROSS BLUE SHIELD MA
MAY35513Medicare ID - Type UnspecifiedCHIROPRACTIC