Bly Chiropractic Clinic, P.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

BLY CHIROPRACTIC CLINIC, P.C.

Practice address

2501 E College Ave
Ste C
Bloomington, IL 61704-2484

Phone

(309) 661-1155

Fax

(309) 661-1043

NPI assigned

Aug 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Timothy J Bly, D.C

Title

Chiropractor/Owner

Phone

(309) 661-1155

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187568000000",
    "number": "1245423748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 E COLLEGE AVE",
            "address_2": "STE C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617042484",
            "telephone_number": "309-661-1155",
            "fax_number": "309-661-1043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 E COLLEGE AVE",
            "address_2": "STE C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617042484",
            "telephone_number": "309-661-1155",
            "fax_number": "309-661-1043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLY CHIROPRACTIC CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-20",
        "last_updated": "2007-08-20",
        "status": "A",
        "authorized_official_last_name": "BLY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIROPRACTOR/OWNER",
        "authorized_official_telephone_number": "309-661-1155",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05715393",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bloomington Township Fire Protection District
• Bloomington-Normal Chiropractic Wellness Center LLC
• Bloomington-Normal Speech Therapy LLC
• Bloomington-Normal Spine Clinic,PC
• Blueze LLC
• Timothy J. Bly, D.C.
• Kelly Blythe-Teats
• BNL Eyecare Inc.
• Erik Paul Boe, M.D.
• Tayaunna Boehm-Binion

• Chiropractor in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.