Provider Demographics
NPI:1811242456
Name:BLUM, JOE (DC)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:
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 1:54751 RUSTIC TER
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1568
Mailing Address - Country:US
Mailing Address - Phone:574-276-4492
Mailing Address - Fax:
Practice Address - Street 1:812 W EDISON RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-2744
Practice Address - Country:US
Practice Address - Phone:574-699-4432
Practice Address - Fax:574-800-0906
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002653A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor