Provider Demographics
NPI:1770906182
Name:BLOOM, AMBER (DC)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 DATE ST APT 4004
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-5434
Mailing Address - Country:US
Mailing Address - Phone:808-861-0494
Mailing Address - Fax:
Practice Address - Street 1:2525 DATE ST APT 4004
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-5434
Practice Address - Country:US
Practice Address - Phone:808-861-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1575111N00000X
LA1788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty