Provider Demographics
NPI:1386759546
Name:BLEAM, WILLIAM RICHARD III (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RICHARD
Last Name:BLEAM
Suffix:III
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 1:5965 EXCHANGE DR STE M
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9276
Mailing Address - Country:US
Mailing Address - Phone:410-795-0400
Mailing Address - Fax:443-687-8735
Practice Address - Street 1:5965 EXCHANGE DR STE M
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-9276
Practice Address - Country:US
Practice Address - Phone:410-795-0400
Practice Address - Fax:410-687-8735
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U99828Medicare UPIN
MDM522Medicare PIN