Provider Demographics
NPI:1326168675
Name:LOSCH, GERALD M (DC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:M
Last Name:LOSCH
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 1:15311 CANYON RD E
Mailing Address - Street 2:SUITE #6
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-7473
Mailing Address - Country:US
Mailing Address - Phone:253-770-7263
Mailing Address - Fax:253-445-2456
Practice Address - Street 1:16714 MERIDIAN E
Practice Address - Street 2:SUITE #6
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6143
Practice Address - Country:US
Practice Address - Phone:253-770-7263
Practice Address - Fax:253-445-2456
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA46388OtherDEPT. LABOR & INDUSTRIES
WALO4749OtherREGENCE
115000289Medicare ID - Type Unspecified
WALO4749OtherREGENCE