Individual
DR. CARL L BLOMENKAMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2853 W BROADWAY ST, BOLIVAR, MO 65613-3379
(417) 326-3888
Mailing address
2853 W BROADWAY ST, PO BOX 16, BOLIVAR, MO 65613-3379
(417) 326-3888
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5008
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5008
MO LISCENSE #
MO
Enumeration date
12/27/2006
Last updated
05/03/2010
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