Provider Demographics
NPI:1366566259
Name:BLUMBERG, MICHAEL E (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:BLUMBERG
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 1:3850 GASKINS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1447
Mailing Address - Country:US
Mailing Address - Phone:804-290-8080
Mailing Address - Fax:804-290-8081
Practice Address - Street 1:3850 GASKINS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1447
Practice Address - Country:US
Practice Address - Phone:804-290-8080
Practice Address - Fax:804-290-8081
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA318306OtherANTHEM BCBS