Provider Demographics
NPI:1548591951
Name:LOOMIS, PAMELA LYN (DC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYN
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10195 BEACH DR SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-2756
Mailing Address - Country:US
Mailing Address - Phone:910-579-8891
Mailing Address - Fax:910-579-0649
Practice Address - Street 1:10195 BEACH DR SW
Practice Address - Street 2:SUITE 1
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2756
Practice Address - Country:US
Practice Address - Phone:910-579-8891
Practice Address - Fax:910-579-0649
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2458033Medicare PIN