Provider Demographics
NPI:1477135689
Name:LOURO, JACK (CHIROPRACTIC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:LOURO
Suffix:
Gender:M
Credentials:CHIROPRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 HWY 35
Mailing Address - Street 2:BUILDING B ANNEX, SUITE 2
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1918
Mailing Address - Country:US
Mailing Address - Phone:732-722-7500
Mailing Address - Fax:732-722-7497
Practice Address - Street 1:2517 HWY 35
Practice Address - Street 2:BUILDING B ANNEX, SUITE 2
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-722-7500
Practice Address - Fax:732-722-7497
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00780400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor