Organization
CARL L. BLOMENKAMP,D.C.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL LAWRENCE BLOMENKAMP D.C. (DIRECTOR)
(417) 326-3888
Entity
Organization
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
261Q00000X
Clinic/Center
Primary
5008
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5008
CHIROPRACTIC LICENSE
MO
Enumeration date
05/04/2010
Last updated
05/04/2010
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