Provider Demographics
NPI:1215134416
Name:BLOOMVILLE CHIROPRACTIC INC
Entity type:Organization
Organization Name:BLOOMVILLE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-983-2117
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:53 S MARION ST
Mailing Address - City:BLOOMVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44818-0236
Mailing Address - Country:US
Mailing Address - Phone:419-983-2117
Mailing Address - Fax:
Practice Address - Street 1:53 S MARION ST
Practice Address - Street 2:
Practice Address - City:BLOOMVILLE
Practice Address - State:OH
Practice Address - Zip Code:44818-0236
Practice Address - Country:US
Practice Address - Phone:419-983-2117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty