Provider Demographics
NPI:1316002306
Name:O'LOUGHLIN, FERNANDO (DC)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
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 1:269 SPRINGDALE TER
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3422
Mailing Address - Country:US
Mailing Address - Phone:215-922-2242
Mailing Address - Fax:215-922-2243
Practice Address - Street 1:826 CHRISTIAN ST SIDE ENTRANCE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3947
Practice Address - Country:US
Practice Address - Phone:215-922-2242
Practice Address - Fax:215-922-2243
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001416434OtherHIGHMARK BLUE SHIELD
PA2103005000OtherINDEPENDENCE BLUE CROSS
PA060617Medicare ID - Type Unspecified