Provider Demographics
NPI:1235201401
Name:VANDERLOOP, JAMES M (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:VANDERLOOP
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 1:3216 MONTE VISTA BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2120
Mailing Address - Country:US
Mailing Address - Phone:505-247-4325
Mailing Address - Fax:
Practice Address - Street 1:3216 MONTE VISTA BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-247-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDC2131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76-0690980OtherTAX ID NUMBER
TX609614Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TXU87168Medicare UPIN