Provider Demographics
NPI:1932706132
Name:BLOMBERG, JOEL STEVEN
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:STEVEN
Last Name:BLOMBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1660
Mailing Address - Country:US
Mailing Address - Phone:320-692-5288
Mailing Address - Fax:
Practice Address - Street 1:805 MAIN ST S
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1660
Practice Address - Country:US
Practice Address - Phone:320-692-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor