Provider Demographics
NPI:1093875122
Name:LOFTUS, JAMES EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:LOFTUS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:LOFTUS
Other - Middle Name:
Other - Last Name:CHIROPRACTIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10612 CLEMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-4543
Mailing Address - Country:US
Mailing Address - Phone:864-985-0099
Mailing Address - Fax:864-985-0095
Practice Address - Street 1:10612 CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4543
Practice Address - Country:US
Practice Address - Phone:864-985-0099
Practice Address - Fax:864-985-0095
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2706Medicaid
SC76262000281Medicare ID - Type Unspecified