Provider Demographics
NPI:1962699199
Name:BLUM, NATHALIE (DC)
Entity type:Individual
Prefix:MRS
First Name:NATHALIE
Middle Name:
Last Name:BLUM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:NATHALIE
Other - Middle Name:
Other - Last Name:SEIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:848 BUCKEYE LN W
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4387
Mailing Address - Country:US
Mailing Address - Phone:904-606-6007
Mailing Address - Fax:904-376-8738
Practice Address - Street 1:12641 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-606-6007
Practice Address - Fax:904-376-8738
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9429111N00000X
FLCH9429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor