Provider Demographics
NPI:1225127384
Name:O'LOUGHLIN, WILLIAM S (DC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:S
Last Name:O'LOUGHLIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 RUSSELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3524
Mailing Address - Country:US
Mailing Address - Phone:301-987-0111
Mailing Address - Fax:301-987-0114
Practice Address - Street 1:811 RUSSELL AVE STE B
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3524
Practice Address - Country:US
Practice Address - Phone:301-987-0111
Practice Address - Fax:301-987-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
G386OtherCAREFIRST DC
522006624OtherTIN
492037Medicare ID - Type Unspecified