Provider Demographics
NPI:1982216941
Name:BLOOM ACUPUNCTURE AND INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:BLOOM ACUPUNCTURE AND INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ACUPUNCTURE
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:916-346-2529
Mailing Address - Street 1:715 SUTTER ST STE D
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2569
Mailing Address - Country:US
Mailing Address - Phone:916-346-2529
Mailing Address - Fax:
Practice Address - Street 1:715 SUTTER ST STE D
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2569
Practice Address - Country:US
Practice Address - Phone:916-346-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty