Provider Demographics
NPI:1043434822
Name:BLUM LTD
Entity type:Organization
Organization Name:BLUM LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-351-4700
Mailing Address - Street 1:10 N ROSELLE RD # 300
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-1592
Mailing Address - Country:US
Mailing Address - Phone:630-351-4700
Mailing Address - Fax:630-351-9206
Practice Address - Street 1:10 N ROSELLE RD # 300
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-1592
Practice Address - Country:US
Practice Address - Phone:630-351-4700
Practice Address - Fax:630-351-9206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623246OtherBCBS
IL558140Medicare UPIN