Provider Demographics
NPI:1316002215
Name:LOEBIG CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LOEBIG CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEBIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-757-5817
Mailing Address - Street 1:754 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:GREATFALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2654
Mailing Address - Country:US
Mailing Address - Phone:703-757-5817
Mailing Address - Fax:
Practice Address - Street 1:754 WALKER RD
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-2654
Practice Address - Country:US
Practice Address - Phone:703-757-5817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH30029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA167445OtherBLUECROSS BLUE SHIELD
VA167524OtherANTHEM
VA=========OtherTAX ID
VA167445OtherBLUECROSS BLUE SHIELD
VA490012Medicare ID - Type Unspecified