Provider Demographics
NPI:1982876330
Name:BLUME FAMILY CHIROPRACTIC & MASSAGE, INC
Entity Type:Organization
Organization Name:BLUME FAMILY CHIROPRACTIC & MASSAGE, INC
Other - Org Name:BLUME HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-330-1800
Mailing Address - Street 1:1611 KRESKY AVE, SUITE108
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-8982
Mailing Address - Country:US
Mailing Address - Phone:360-330-1800
Mailing Address - Fax:360-330-5866
Practice Address - Street 1:1611 KRESKY AVE STE 108
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-8982
Practice Address - Country:US
Practice Address - Phone:360-330-1800
Practice Address - Fax:360-330-5866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0254923OtherWASHINGTON STATE DEPT OF LABOR & INDUSTRIES
WAG8872103Medicare PIN