Provider Demographics
NPI:1902948359
Name:PAUL R. BLOMERTH, D.C.
Entity Type:Organization
Organization Name:PAUL R. BLOMERTH, D.C.
Other - Org Name:LUDLOW CHIROPRACTIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BLOMERTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-583-8326
Mailing Address - Street 1:77 WINSOR ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-3469
Mailing Address - Country:US
Mailing Address - Phone:413-583-0832
Mailing Address - Fax:413-583-6133
Practice Address - Street 1:77 WINSOR ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3469
Practice Address - Country:US
Practice Address - Phone:413-583-0832
Practice Address - Fax:413-583-6133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0000835111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39115OtherBCBS GROUP NUMBER
MA1611968Medicaid
MA1611968Medicaid
MAY35581Medicare ID - Type UnspecifiedMEDICARE