Provider Demographics
NPI:1720829831
Name:BLUML, MACY (DC)
Entity type:Individual
Prefix:DR
First Name:MACY
Middle Name:
Last Name:BLUML
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MACY
Other - Middle Name:
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2822 RAMADA WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5730
Mailing Address - Country:US
Mailing Address - Phone:920-430-0933
Mailing Address - Fax:
Practice Address - Street 1:2822 RAMADA WAY STE 110
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5730
Practice Address - Country:US
Practice Address - Phone:920-430-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6136-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor