Provider Demographics
NPI:1427018084
Name:LOEB, JAY DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:DOUGLAS
Last Name:LOEB
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 1:490 PENN LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:PA
Mailing Address - Zip Code:15126
Mailing Address - Country:US
Mailing Address - Phone:724-695-0788
Mailing Address - Fax:724-695-0789
Practice Address - Street 1:490 PENN LINCOLN DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:PA
Practice Address - Zip Code:15126
Practice Address - Country:US
Practice Address - Phone:724-695-0788
Practice Address - Fax:724-695-0789
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3563L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA17458Medicare UPIN
514650Medicare ID - Type Unspecified