Provider Demographics
NPI:1215055801
Name:BLOOMQUIST, THUMPER (DC)
Entity type:Individual
Prefix:DR
First Name:THUMPER
Middle Name:
Last Name:BLOOMQUIST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W. VICTORY BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1200
Mailing Address - Country:US
Mailing Address - Phone:818-848-9600
Mailing Address - Fax:208-275-2137
Practice Address - Street 1:2300 W VICTORY BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1256
Practice Address - Country:US
Practice Address - Phone:818-848-9600
Practice Address - Fax:208-275-2137
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA013939111NI0900X, 111NN0400X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NI0900XChiropractic ProvidersChiropractorInternist
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition