Organization
IN BLOOM WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADI GORDON (OWNER)
(765) 404-4002
Entity
Organization
Contact information
Practice address
215 W NORTH 9TH ST, SHELBYVILLE, IL 62565-1015
(765) 404-4002
(217) 615-1142
Mailing address
215 W NORTH 9TH ST, SHELBYVILLE, IL 62565-1015
(765) 404-4002
(217) 615-1142
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/06/2023
Last updated
07/06/2023
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