Provider Demographics
NPI:1811903750
Name:BLOMERTH, STEVEN A (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:BLOMERTH
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 1:215 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35513OtherBLUE CROSS BLUE SHIELD MA
MAY35513Medicare ID - Type Unspecified