Active NPI
Bruce David Bloom, DC
- Nutrition Chiropractor
- White Plains, NY
National Provider Identifier
1619174174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Chiropractor
- License
- X003040-1
- Practice address
- 25 Lake St
White Plains, NY 10603-4032 - Phone
- (919) 949-6009
- NPI assigned
- Jun 28, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Chiropractor | 111NN1001X | X003040-1 | NY | Primary |
Addresses
Primary practice location
25 Lake St
White Plains, NY 10603-4032
Mailing address
25 Lake St
White Plains, NY 10603-4032
Phone (919) 949-6009
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003040 | NY | MD | Mental Health Counselor |
| X003040-1 | NY | MD | Nutrition Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619174174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 LAKE ST",
"city": "WHITE PLAINS",
"state": "NY",
"postal_code": "106034032",
"telephone_number": "919-949-6009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 LAKE ST",
"city": "WHITE PLAINS",
"state": "NY",
"postal_code": "106034032",
"telephone_number": "919-949-6009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOM",
"first_name": "BRUCE",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NN1001X",
"taxonomy_group": "",
"desc": "Chiropractor, Nutrition",
"state": "NY",
"license": "X003040-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White Plains, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.