Organization
BLY CHIROPRACTIC CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY J BLY D.C (CHIROPRACTOR/OWNER)
(309) 661-1155
Entity
Organization
Contact information
Practice address
2501 E COLLEGE AVE, STE C, BLOOMINGTON, IL 61704-2484
(309) 661-1155
(309) 661-1043
Mailing address
2501 E COLLEGE AVE, STE C, BLOOMINGTON, IL 61704-2484
(309) 661-1155
(309) 661-1043
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05715393
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/20/2007
Last updated
08/20/2007
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