Provider Demographics
NPI:1801084199
Name:BLAUM CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:BLAUM CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:BLAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-287-3090
Mailing Address - Street 1:105 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1209
Mailing Address - Country:US
Mailing Address - Phone:570-287-3090
Mailing Address - Fax:570-287-3060
Practice Address - Street 1:105 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1209
Practice Address - Country:US
Practice Address - Phone:570-287-3090
Practice Address - Fax:570-287-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-4283-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015554030002Medicaid
PA587694Medicare PIN
PA0015554030002Medicaid